May 25. 2010 10:37

I just want to thank you, Dr. Brown for the list of tests I should have done in my medical workup for Osteoporosis.  I will take this list to my Dr. and ask him if these tests are being done on me and for my health.  I was first diagnosed with severe Osteoporosis in 1997 and had to retire from my job in 1998 since I could no longer do what was required.  I actually was afraid to do anything for fear I would break.  since then for many years I was told I no longer had this, then in 2010 told I did have Osteoporosis again.  I had been getting bone density tests every 2 years.  Can this come and go as it chooses?  I am so confused about this.

Loretta Davis

May 25. 2010 15:04

Hi,
I am very grateful to find support through your website and blogs.
I never was tested on celiac disease. But eating wheat definetely makes me ill.I eat gluten-free.
I would like to learn why people with celiac disease are more prone to bone loss.
Thanks

Monika Munzinger

May 26. 2010 22:28

I was also tested for an additional condition, which it turns out I have--it is called MGUS, or Monoclonal Gammopathy of Undetermined Significance.  It is harmless, but in rare cases can develop into Multiple Myeloma, which is a blood/bone cancer.  My doctor thought it might explain my osteoporosis.

The test for it looks for an abnormal protein in the blood.

Anne Green

June 2. 2010 14:24

Dear Monika,

The quick answer to your question is that when someone with celiac eats gluten, the autoimmune reaction in the gut makes the lining of the intestines so inflamed that the person cannot absorb nutrients from food. As I've discussed in my articles on nutrition and bone health (see betterbones.com/bonenutrition), the bones are the storehouse of nutrients for the rest of the body, and when they're unable to get these nutrients from food because of the celiac-related inflammation, the body turns to the bones to replace those lost nutrients, and that's where osteoporosis develops. This in a nutshell is why it's essential for people with celiac disease to avoid gluten - even a little will trigger the autoimmune response. The NIH has a terrific web page describing the relationship at www.niams.nih.gov/health_info/bone/osteoporosis/conditions_behaviors/celiac.asp#b

Susan

June 2. 2010 16:25

Are there other conditions to be evaluated in a medical workup?
I've had my parathyroin checked and its ok and a celia test and it was normal.  My Nxt shows I'm still loosing bone  48.6.  I've had a stroke and am off estrogen and am on Plavix so I must watch my vit K intake.  Is there anything else to look for?  I exercise 5-6 days a week (walk 4 days, workout 2 days)

valeri jones

June 9. 2010 16:27

My doctor says that Fosomax aids your bones in better absorption of calcium.  I don't remember reading that anywhere.  Can you reply?

Gail Bullard

June 9. 2010 16:37

Fosamax works by preventing bone breakdown, which leads to denser bone over time. Vitamin D and magnesium are what improve calcium absorption and utilization. Please see our articles here: http://www.betterbones.com/osteoporosis/osteoporosistreatment.aspx, here: http://www.betterbones.com/bonenutrition/vitamin-d.aspx, and here: http://www.betterbones.com/bonenutrition/magnesium.aspx

Susan

October 31. 2010 23:38

I am losing all my calcium through my urine, and don't get how to stop that. Is my only option the HCTZ? If my density is so terrible at age 55 will I be broken in ten years? I will be retested in a month after being on the lowest dose of hctz, my Dr. told me not to take my calcium for the next 24 hr. urine collection, will that be an accurate test since I do take my calcium daily? My d levels are fine. I was having symptoms that made me believe all the calcium that wasn't going into my bones was lining my arteries, turned out I have a meningioma, which probably had a little growth spurt from Activella hormones I took to help with the horrible menopause and to help my bones which I had sensed at that time were weak. That was almost three years ago, I'm over the awful meno, and had quit the hormones after the diagnosis of meningioma (I was on them a year)I had focused radiation to the tumor a year ago and am now on yearly mri's. I am now addressing the osteoporosis and can't figure out the excreting calcium. Any clarification would be helpful. I am not taking any osteo drugs but am taking the HCTZ and don't understand if I'll have to take it for life and if there is something wrong with my kidneys.

Sue Irvine

November 1. 2010 09:49

Dear Sue,

With regard to your specific health issues, we can't really comment because your doctor is the best person to work with you on those, but we can suggest that your doctor likely wanted you to stop taking your calcium because he or she wants to know whether the calcium you're losing in your urine is coming entirely from the calcium pill (because you're not absorbing the calcium), or whether you're losing it from your bones as well. If you're not absorbing it, there are a number of reasons why that could be, not just vitamin D deficiency; our article on calcium explains that you need to consider not only your vitamin D level, but how much magnesium and vitamin K you're getting as well. If you're not getting the right balance of all these nutrients, it could affect your ability to absorb calcium into your bones. Please see: www.betterbones.com/bonenutrition/calciumandbone.aspx as well as www.betterbones.com/bonenutrition/default.aspx

Also, in regard to why you're excreting calcium, you should consider the possibility that you are in a state of metabolic acidosis (acidic pH), and that might be one reason you're losing calcium. Have you tried taking your urinary pH? Read about alkaline balance here: www.betterbones.com/alkalinebalance/phbalanceandbones.aspx and about testing your pH here: www.betterbones.com/alkalinebalance/phtesting.aspx, and about how to develop an alkaline diet here: www.betterbones.com/alkalinebalance/default.aspx

If there is an underlying problem with your kidneys, improving your nutrition and alkaline balance won't likely solve it, but it may help matters as you look for solutions. You have our best wishes for improved health.

Managing Editor

March 28. 2011 16:16

I just found your site.  What a service you are providing.  I was recently diagnosed with chronic intistinal failure, chronic small bowel infection, short bowel syndrome, severe radiation enteritis and last but not least, chronic pseudo obstruction.  All these are a result of a stage 3/4 colon cancer 12 years ago.  The 3/4 was because the Drs. found cancer cells throughout my lymph system, but it hadn't settled in any other organs.  My body rejected the chemo with oragn failure.  So, my only chance at survival (I was 45 and had 3 teens at home) was boosted radiation. The possible side effects were clearly explained...but I gladly accepted them if it gave me a chance to live.  So, 12 years later...here I am.  I'm on TPN probably for the rest of my life.  I have osteopenia and my TPN team has me going for IV Palmidronate (sp?) every 3 months.  I much perfer that to the oral meds I was taking.  My question is...since I don't absorb anything intestinally...what should I know about Calcium, Vit D and magnesium according to my new life?  I have paperwork from the IV clinic, but it only applies to 'regular' people who eat and absorb.  There is calcium and Vit D and mag. in my TPN feeding bags, but the levels appear very low to me.  I'm booked into a TPN 'clinic' in mid April.  This will be my first since my TPN was started in November.  I have gained 40 lbs. and I'm thrilled about it.  I got down to 93 lbs and I'm 5'10" tall.  I looked awful.  I'm back to looking more like myself.  I would appreciate any and all suggestions to take with me to discuss with my TPN team at the clinic.  My GI TPN Dr. will be there, my two specialized TPN nurses and my dietician and nutritionist will all be in attendance so it's a perfect time to figure out what, if anything needs to be changed.  I'm due for another bone density test in June.
Thank you so much.

Kathie Douglas

March 29. 2011 13:43

Valeri, there are many conditions (and medications for other conditions) that contribute to bone loss. Anticoagulants are among the medications that can lead to osteopenia or osteoporosis. Please see betterbones.com/osteoporosis/secondaryosteoporosis.aspx for a list of different factors that can be related.

Susan Brown, PhD

March 29. 2011 13:49

Dear Kathie,

What an amazing story! Congratulations on making it through a decade plus of cancer treatment.

In answer to your question, for most people who want to build bone after an episode of severe bone loss, we would suggest an alkaline diet of fruits and vegetables (see betterbones.com/alkalinebalance/default.aspx), undertake suitable exercise and stress-reduction programs, and try to get all of the 20 key bone-building nutrients described in Dr. Brown's article here: betterbones.com/bonenutrition/20keybonenutrients.aspx. However, your malabsorption problem and past cancer treatment, not to mention the need for TPN, all complicate matters greatly. Such complex health problems can't be addressed in this blog, as we don't know nearly enough about you and your medical circumstances to offer informed recommendations. It might be helpful for you and your team to work directly with Dr. Brown to look at ways your TPN can be adjusted to better support your bone health. You can use the Personal Consultations link to contact her at the Center for Better Bones. It might also be worthwhile to undertake bone breakdown testing (see betterbones.com/bonehealth/bonebreakdowntests.aspx) to determine whether your bone loss is still ongoing.

Hope that helps! Best of luck to you!

Managing Editor

August 30. 2011 19:08

I am a 53-year-old who was recently diagnosed with Crohn's disease.  I've had chronic diarrhea for 30 years, but otherwide felt great (even running marathons).  The diagnosis came about after suffering severe abdominal pain and a CT scan revealed an intestinal obstruction and a fistula between my small intestine and distal end of the colon.  I had other tests while hospitalized which confirmed the diagnosis.  I am currently on Remicade.  I am on the specific carbohydrate diet and take supplements of glutamine, borage oil, probiotics, vitamin D, and bone health supplement.

I have a history of osteopenia confirmed by bone scans in 2006 and 2009.  The two scan results were nearly identical.  I suffered a wrist fracture in 2006 and another in 2009 as a result of falling while hiking in wet slippery steep conditions.  

Is there anything else I should be doing to calm my intestines as well as stop the bone loss or even build new bone?  Are there tests I should request from my gastroenterologist?  I have refused the prescription drugs such as Fosamax suggested by my gynocologist for years.

Susan

August 31. 2011 09:29

Dear Susan,

First, improving your digestion should do a great deal to help prevent continued bone loss. Inflammation in the digestive tract can be the starting point for inflammation throughout the body, which affects the bones. Most of what you have described sounds like a good strategy (although Susan Brown's tips for better digestion might also be helpful -- see her article here: http://www.betterbones.com/bonenutrition/betterdigestion.aspx. We also would suggest, if you're not already doing so, that you take a high-quality multivitamin supplement given that you likely have absorption issues related to your Crohn's disease.

Second, if your bone scans from 2006 and 2009 are identical, that's something to cheer -- it means your bones are stable, and you're not continuing to lose bone. That doesn't mean that you don't have weak bones (as your two fractures attest), so the important thing now is to take steps to improve your bones' strength -- weight training exercises are perhaps among the best methods for improving bone strength, and since you mention hiking it might be helpful for you to add a weight vest when you hike or walk, and perhaps carry hand or ankle weights. Other exercise regimens you may want to consider are described in Dr. Brown's article on exercise here: http://www.betterbones.com/healthylifestyle/exercise-bonesandosteoporosis.aspx. We would also like to highlight the importance of vitamin K2, particularly in the form of MK-7, in maintaining bone health. Dr. Brown's article on vitamin K is here: http://www.betterbones.com/bonenutrition/vitamin-k/benefits.aspx

As far as additional testing is concerned, your GI issues are a likely culprit for your bone health concerns, but that doesn't mean they're the only one. Presumably you've had a vitamin D test if you're on vitamin D supplements (if not, you should get one, if only to ensure that the dose you're using is effective), but Dr. Brown recommends additional tests that might be beneficial in detecting hidden bone hazards. Those tests are listed here: http://www.betterbones.com/bonehealth/medicaltestingforosteoporosis.aspx. We hope these are helpful!

Managing Editor

October 20. 2011 12:07

Anne: I was diagnosed with MGUS quite incidentally while undergoing a ton of unnecessary tests before diagnosing a secondary adrenal insufficiency in 2004. I still have it, and it hasn't changed.  I've undergone two bone marrow biopsies, which were also unnecessary, I'm sure. I'm now 54, and the MGUS was diagnosed when I was 47. I may have had it all my life.  Or not...  Who knows?  It may be because of my childhood kidney disease.  Or not...  It may be because of connective tissue disease and multiple types of arthritis.  Who knows...?  Two things I know for certain, thanks to a wonderful hematologist.  I don't have multiple myeloma, and chances of developing it are miniscule unless I live to be 100 or so.  And since my osteoporosis started in my 20s due to childhood kidney disease, it isn't contributing to that. As an aside, despite a severe allergy to the most common and effective drug for renal calcium leak, my nephrologist has found a combo that has finally reduced my 24 hour dump of calcium from gargantuan to within normal limits. IOW, it has NOTHING to do with MGUS. I suggest an annual visit to a hematologist, and make sure your PCP does a 24-hour urine for calcium and protein.  Good luck.

~Deb

Deb