Let me tell you about Janet. Janet is a thin, energetic 57-year-old woman now seven years into menopause who came to the Center for Better Bones for the first time last week. Upon sitting down the first words out of her mouth were, “My doctor has told me that I have the bones of an 80-year-old and that I could fracture just picking up a heavy bag of groceries. I was told I had to take an osteoporosis drug, but I have friends using these drugs. I know about their potential negative effects, and I really don’t want to take one. The doctor has scared me to death. Can you help me?”
The first step in helping Janet was to do a complete assessment of her health situation and circumstances. Janet’s answers to my questions about her health and medical history were imprecise. While she had been given three bone density tests, she only had one in her possession. She knew that she taken some calcium and vitamin D on and off, and she recalled using hormones a year or so after menopause, but did not know exactly what she took, or for how long. She had used a steroid inhaler for bouts of asthma a few times over the last two decades, but she wasn’t sure about the dates or medication dose. She was recently tested for vitamin D, but did not know her level; she was just told that it was “normal.” Further, at one point her doctor mentioned her thyroid levels were a bit high. Her medication dose was lowered, but she did not know if a retest had been done to make sure the new dose was correct.
While Janet’s fear of the situation was vibrant and clear, her recollection of the circumstances leading up to it were not. Now we had to reconstruct her history to determine if she was actually losing excess bone, and if so, why.
After considerable effort on both our parts, we were able to conclude that Janet need not be scared. She did not have the “bones of an 80-year-old”, and her 10 year fracture risk was low. Here’s what we found:
• She lost 8% of her bone mass during her menopause transition, which is exactly what the average North American woman loses during. In her case, the loss looked worse to the doctor because she was thin and started menopause with a low bone density reading. As I have mentioned before, bone density machines measure area rather than density and thin folks with small bones come up with a lower “bone density” reading. This need not be a great concern if bone loss is not on-going. In Janet’s case, six months into the Better Bones Program her bone resorption (NTx) test showed she had halted her menopausal bone loss.
• The report of a normal vitamin D level (which was barely the 32 ng/mL needed to absorb adequate calcium) came from a blood tests taken in the late fall while taking 1,000 IU of vitamin D. We knew by midwinter she would be vitamin D deficient if she didn’t increase the vitamin D intake well beyond the 1,000 IU.
• Analysis of her thyroid tests over time revealed that for a period she was given excess thyroid medication and this might well have accelerated bone loss.
• Unexpectedly, her C-reactive protein test (a non-specific marker of inflammation) was high, indicating that she may well be undergoing an inflammatory process and in need of higher levels of antioxidants. Proper supplementation corrected this additional fracture risk.
“Take Heart and Take Action” is my favorite motto. In this case, the “action” pertains to you and your medical records. If Janet had been tracking her own lab results, she would have been informed all along and subsequently less scared and shocked when her doctor gave her the news about her bones.
• Keep copies of your medical records
• Get copies of your medical test results
• Take the time to chart out the changes over time.