Saturday, November 19, 2011

Osteopenia, Osteoporosis and Diabetes

Well, I just had a DXA bone scan today, which they recommend every 2 years for all men over 70 and women over 65, but younger, if you have risk factors. And I found out that Type 1 in particular is considered a risk factor. I'm 63, but I guess I count as having a risk factor.

Turned out that I have osteopenia (low bone mineral density, but not as low as in osteoporosis) in the femurs, but not in the spine. That surprised me, because I haven't had diabetes as long as some (It started at age 43 and I was formally diagnosed at 45), and osteoporosis doesn't run in my family. :-(

The risk factors include normal to low BMI, thin bone structure, smoking, auto-immune diseases, excessive drinking, not enough calcium and vitamin D in bone-forming years, family history, history of anorexia (diabulimia!) and inactivity. I do have thin bone structure, autoimmune diseases, and (ashamedly!) inactivity.

So there is definite evidence that women (but also men) with Type 1 are at increased risk, and osteopenia is a risk factor for osteoporosis. One article said that 50% of Caucasian women will break a bone at some point in their lives.

But the really surprising fact is that, although Type 2 women tend to have INCREASED bone mineral density, at least partly attributable to the fact that their bones get more weight-bearing exercise, they are also at increased risk of fractures. And no one knows why.

I also read up on treatment, and there is no general consensus there. On the one hand, taking drugs like bisphosphonates and other drugs could actually increase bone mass to some extent, but in osteopenia, the person might never experience a fracture anyway, and why take a drug that may not be needed? Osteoporosis, being more severe, with a higher risk of fracture is another story, but again, the question is why wait until you are at great risk?

So I'm going to continue reading up about it, and going to delay making any kind of decision until I have a chance to talk with both my PCP's APN, and my Endo's APN -- I'm taking enough drugs as it is, and since all the available drugs have unpleasant side effects, I'm not going to rush into anything. But I would be interested in any insight any of you may have! :-)


  1. I was told I have osteopenia in 2003 and was put on Fosamax. I started having stomach problems and was given a drug for that. I did follow the instructions to a T as far as drinking water, sitting up and whatever else you are supposed to do. Once I quit taking the Fosamax, the stomach issues went away.

    One strange side effect that I had that I have never seen on anything discussing side effects for Fosamax is lows. My pharmacist was supposed to file a report with Merck when I talked to him about it. I am a creature of habit and do the exact same thing every day. One day a week (it was the same exact day every week) I would have very bad lows all day. It was like I could fill up on junk food and not take any insulin. The only thing that had changed was the Fosamax that I took once a week. I would take the Fosamax the same day every weekend and about mid-week, the lows would start and it was only for one day, the same day every week.

    Another thing I did not know at the time but Fosamax has a very long half-life. It is something like 10 years so it takes about 20 years to get out of your system. I found that out when I needed to get a tooth pulled and the dentist asked if I took it. When I told him I haven’t taken it since late 2005 or early 2006, he told me about the half life. Whoever would have thought to look at a drug you haven’t taken in years!

  2. "Why take a drug that may not be needed?" is one POV. Another is, why take a chance that you don't have to?

    My father had osteoporosis -- and a broken hip. With that risk factor and mild osteopenia, for me it was a no-brainer to take it. I'm also still taking it more than five years later, which is usually stated as the time limit. The doctors have very reasonable theoretical concern about suppressing bone remodeling for too long, but no data at all to show that it causes any problem. (I remember reading a case report about a broken bone failing to heal until alendronate was discontinued, but that's all I've found.) The main reason for the five-year limits is simply that most studies stopped at five years! That's the same reason that antidepressants aren't supposed to be taken long term -- lack of studies. But a few bisphosphonate studies have continued longer, and I've seen charts showing that bone density decreases in the next five years if the drug is stopped, where it's maintained if the drug is continued.

    Kelly mentions the concern of dentists, but I looked this up when I started taking alendronate, and the concern is misplaced. Yes, the drug remains in bone, but it's sequestered. Only what's on the surface is active, and it's only there for a few weeks. If I ever break a bone, or need to get a tooth implant, I'll stop taking it, but otherwise I see the risks as small.

    There are two well documented major side effects. One is spontaneous femur fractures, of which I think about 500 have been reported. The specific type of fracture is so rare that there's no question it's related. But it's still an incredibly small percentage. Compared with the risk of fractures due to inadequate bone, which is thousands of times greater, I'll take the drug.

    The other major side effect is osteonecrosis of the jaw. However, this has only occurred in patients taking massive doses of bisphosphonates intravenously, generally immunocompromised patients, HIV and chemo patients. Because this relates to the jaw, it may be the reason that dentists have picked up so strongly on bisphosphonates, even though it doesn't relate to the issues dentists normally deal with.

    Gut irritation is a less severe side effect. That may be the source of Kelly's problem, though most people tolerate it OK when following the instructions. There are actually two reasons for the protocol: that, and the fact that the drugs are absorbed very poorly from the intestine (less than 0.5% bioavailability), and that availability drops much farther when there's anything else in the stomach.