Causes of osteoporosis and bone markers via blood and urine testing

Hi arlene, did you doctor give you nothing additional in terms of the cause. In my case I am not aware of any in my family having osteo, however this might be due to the lack of diagnosis, my grandfather did break his hip at 88, presumably his bones were not in good shape. I also have a light frame, this is the genetic part, I cannot imagine that one can do nothing in terms of diet and tracking the chain of causes through hormones etc to see how to address this. I have also done plenty of exercise including weight bearing over the years, perhaps things would have been worse if we had not done so, and perhaps we lacked the necessary minerals and vitamins for this to be effective?

I am just starting to realise doctors need to do more. They should be isolating the exact cause/s and address that. I could not take HRT because I had two sisters with breast cancer but that has not been proven as the cause. I have Crohns that is in remission and that could have done some damage especially the drugs to pull it up like hydrocortisone in high doses. 

No proof has been shown because no one has asked or checked. 

Wow that is comprehensive and you have done more than most people to isolate the cause. I am pretty certain that vitamin D3 is hugely important so that doctor is wrong to say it is not connected. It works with calcium as far as I know and without it a major cause of osteoporosis is present. Another one is magnesium.

People who have been lacking in magnesium have been found to have osteoporosis. Boron is in prunes. 

Another thing we need to look at is our other meds and I have quite a few.

One culprit could be Pariet which contains rabeprazole and I take that for acid reflux. I have a tzaski ring (spelling) at base of my stomach.

Schatzki  ring (proper spelling)

Hi Kathleen, your comment about the doctors needing to do more is the primary reason I am trying to educate myself on my condition and how it should be treated. It highlights the issues faced by many others on this forum. Doctors do not appear motivated to treat patients as individuals, and too easily prescribe drugs as a standard protocol when there are alternative ways to treat that ar less harmful. I am not sure if this is due to incentives from drug companies, incomplete understanding of the illness oor of the patient, a combination, or other unknown reasons. The fact that the recommended ranges of Vit D vary from <50nmol or <75nmol as deficient depending upon the authority is not acceptable. A variance of 50% is effectively malpractice. My endocrinologist tells me Vit D is unlikely to be the cause in the face of so much research but does not support his own position. Does not advise me on supplements diet or exercise, and suggest I should be using Prolia or similar without any reflection on other options. I am not prepared to be driven by approachers like this to deal with my own health

Hi tbulley,  I read your response to Kathleen with interest and some sympathy - with interest because I've rarely seen such a castigation of doctors, and with sympathy because of your obvious frustration at your unsatisfactory treatment. 

You listed:

 " not motivated to treat patients as individuals" (? lazy and rigid in their approach)

 " too easily prescribe drugs" (? incompetent)

 "incentives from drug companies" (? corrupt)

 "incomplete understanding of the illness" (? not properly trained or not very bright)

 " suggests I should be using Prolia without any reflection on other options"  (? unprofessional)

 "  malpractice" re. his views on Vit D (speaks for itself).

 " does not advise me on supplements, diet or exercise" (? negligent).

Were you to put these views to your doctor he could well initiate legal action. 

I completely accept that these are your strongly held views and I think it's awful that any doctor, albeit unknowingly, would have his patient in this state. You are obviously a very intelligent and resourceful woman and yet - here you are!  Does this doctor have a clue about your anger and concerns? If he doesn't, he should!  If he does, then get another specialist - NOT a GP . . . A GP knows a little about a large range of medical conditions and therefore is spread very thinly . A specialist knows a lot about very little. Both have a value. 

I have worked in 4 major city hospitals over 37 years as a paramedic and it was plenty of time to form a view about the profession - from junior doctors to consultants.  Doctors are like any other workers:   

I've met lazy ones, ones I wouldn't consult, competent ones, world-class inspirational ones. I've seen those with total dedication to their patients - whose family life and marriages have therefore suffered badly, and those, who though very ill themselves, just kept working until the end. I'm sure we all know ordinary people like this also. 

However, I have never encountered a doctor who was in medicine for the money  - as those who practice other professions often are. To me, they genuinely want the best for their patients, though, of course, some of them fail abysmally in this. Your post vividly draws attention to this deficit.

 

Finally, you said at the start of your post "I am trying to educate myself on my condition and how it should be treated". Are you saying you need to know more? Great. But becoming your own doctor, as it were, I think is a mistake - and an isolated place.  A half-way position would perhaps be to 'unearth' a really good specialist who has studied, and practiced, and supervised, and researched the area for decades.. . He HAS to know more than you at present and would be more than able to discuss your concerns and answer your probing questions. You never know, both of you may enjoy it !!

Kind Regards,   J

 

I tried to respond yesterday but there was an issue with the site.

Vitamin D is a major cause so your doctor is wrong about that.

My husband requires twice what I have and that information came from our blood tests. Have you had the level checked in your bloods?

Calcium can be checked there but there is an issue with that and it is more complicated than I realised. Apparently, calcium can be drawn from the bones when required. I am doing a small top up now.

Magnesium is another one to watch as people with osteoporosis have been found to be lacking that.

It is indeed hard to find a specialist who will do the necessary investigations.

There is much still to learn about our bones.

 

Juno, tbully listed all that information in good faith and if they were her experiences then she should be believed. Not everyone is lucky enough to find excellent doctors who take good care of them.

My Dexa scan took nothing into account. My husband is nearly a foot taller than I am and he was measured the same as I was except for our gender. I notice that some people have variations noted which my husband mentioned but it was not done for us. 

GPs cannot be expected to know everything but some are ready and willing to research or follow up on our research. 

I have not seen a specialist about my bones.

Tbully should be praised for being so thorough in her endeavours to help her bones.

Patients have been the ones changing some care in relation to bones. Doctors are listening. Vitamin K2 would be one example.

I told my GP about the test to check if it was safe to have teeth extracted which she thanked me for and passed it along to other GPs.

People power is often good especially when we are respectful.

Hi Kathleen, of course I  believe her!   Otherwise I wouldn't have responded. Her frustration and annoyance were manifest.  Also, perhaps a sense of abandonment. . . . 

You also say that some GPs  " are ready and willing to research . . "  I'm sure there are SOME who aren't overly busy (those in rural areas?)  but certainly not the majority.  All the GPs I know are endlessly busy and overworked - too many patients, vast amounts of compulsory paperwork, and now must be overly cautious (and therefore ordering 'unnecessary tests'  because of constant fear of litigation. . . Tough job. 

J

J

PS.  Don't know where the' smiley face'  came from! 

Australia may be a little better then because mine would research and follow through. She was in great demand because she was caring and thorough. She moved interstate unfortunately but did refer us to one she knew was quality thorough. Our appointments maybe longer too. I am always urged to make a double one which is half an hour. Australians usually are not litigious either. 

Equally not quality, stupid auto correct!

I disagree.  I don't think any of us would say that we'd ever without going to medical school become more knowledgeable than our doctors.  But as patients we can indeed learn more than most doctors about a particular condition.  I happen to be lucky, for example, that the doctor who diagnosed my PMR has pretty much left me alone to manage my own prednisone tapering but even she messed me up quite badly last year when I had got to 1.5 mg pred and instead of renewing my prescription she told me to "use up the rest of your tablets and see what happens".  What happened was a flare, and I had great misgivings when I tried to do as she said, feeling it was a mistake but hoping for the best.  This was a year ago and I'm still not back to 1.5.  So that's a simple example of knowing more than my doctor, even a good doctor.  As for osteoporosis, when I improved my bone density without taking medication she asked me how I did it.  So that's another example of a doctor not knowing everything - and I know more because I'm free to read about "alternative" i.e. non-allopathic modalities. Doesn't mean she doesn't know infinitely more about diseases than I ever will.  But in this very small slice of information which affects me personally I'm able to become an expert. 

Happens all the time - something to do with punctuation, the program reads it as an emoticon even when we don't mean it, and I have never figured out which symbols do this.  

 

Fair enough!    J

I can’t remember where you are Juno but here in Australia we have some greedy specialists who overcharge their patients and many cannot afford their exorbitant costs. I am lucky as my specialist for Crohns bulk bills me. Another good one is an oral specialist who accepted my private health fund card plus Medicare card to do some extractions and oral checks.

But you have to shop around in Australia as many charge far too much which many people cannot afford. There is no need to charge so much as others do just fine charging reasonably.

Hi Juno

“Hi tbulley,  I read your response to Kathleen with interest and some sympathy - with interest because I've rarely seen such a castigation of doctors, and with sympathy because of your obvious frustration at your unsatisfactory treatment. “

Perhaps you have judged my attitude on the basis of one or a couple of my posts, however this was a direct response to another so perhaps some context was lost.

 " not motivated to treat patients as individuals" (? lazy and rigid in their approach).”

This arises in large societies. Standardised protocols are required to treat a population. It accepts there will some casualties that fall outside the norm. This does not have to be laziness but its how medicine and science ensure standards are adhered to, and for good reason, but it can have negative consequences for individuals. When my elder daughter reacted to a vaccination with temp paralysis down one side, the pediatrician said with such high reactivity she should not be vaccinated., at least until her immune system had developed and settled. The protocol for this in Africa in the 90’s was to inoculate all children at a very early age because this was the most effective way to access the largest cohort. Its recognised there will be fall out doing this to immature immune systems, however its seen as the better option to vaccinate the greatest number and this is while they are very young and still needing post natal care.

 " too easily prescribe drugs" (? incompetent)”

Fleming warned about the indiscriminate use of antibiotics. If doctors are unable to accurately diagnose, there is a good chance an antibiotic will knock out many suspects. My wife was given 5 treatment of antibiotics for acute tonsilitis over several months, the infection returning immediately again at the end of the 5th round. I insisted she get better treatment than endless rounds of ineffective antibiotics. A natural healer suggested she was suppressing grief, and could be resolved by acknowledging this and released. This cleared the tonsilitis until a few years later when she went through a similar loss. No randomised, double blind trials as required to satisfy medical science, but as individuals we just wanted her to get better.

 "incentives from drug companies" (? corrupt)”

I would say that most people will respond to the appropriate incentive. Money exchanges for most things, except guaranteed health or happiness and never buys immortality. You might recall the tobacco industry hiring medical experts to argue the case that smoking tobacco could not be proven to be harmful to your health. Because of the huge sums of money involved, plenty of medical experts were willing to protect this lucrative industry for a price. Intuitively we might argue that inhaling lots of smoke from burning leaves is sure to be harmful, but medical evidence requires inductive reasoning and tested evidence not intuition.  Does this mean drug companies are all motivated by profit? Yes, it does. What drug company will invest huge sums of money into complex and prescriptive trials if they don’t think they will get their money, and more, back? If there are better and more natural ways to reduce cholesterol than statins do you think this industry will risk their business to find it?

 "incomplete understanding of the illness" (? not properly trained or not very bright)”

Understanding the complex interactions of all bodily systems is not possible at the moment. We don’t understand genetics well enough and cannot even prescribe the desired range for Boron or Vitamin D in the body. I often ask practitioners questions which they cannot answer so I don’t expect omniscience. Drug trials try to remove all extraneous factors, double blind placebo trials, however end up with very narrow conclusions. I have used iridologists who get a better systemic view of overall health, however they still miss a lot of important details that only show through blood tests etc.

 " suggests I should be using Prolia without any reflection on other options"  (? unprofessional)”

Just shortsighted, as a GP, he does not have the training or experience to know the mechanism of Prolia, or the issues only now being seen. Since his own life does not depend on using or not using Prolia this is not surprising, but my life might well depend upon it, so I am going to look carefully before he leaps.

 "  malpractice" re. his views on Vit D (speaks for itself).”

This is directed at the entire practice of allopathy not one practitioner. How is it possible to ignore or accept that multiple authorities can be 50% different in something defined as deficient. In the same info pack given to me following my diagnosis I was given both the 50nmol and 75nmol/l as minimum levels.”‘OK Einstein, which one is it or are there more opinions I don’t know about?”. If these levels are being defined based upon the process of science, how can it be adrift by 50%. 5% is acceptable error, do you think 50% deviance indicates goodpractice or malptractice?

 " does not advise me on supplements, diet or exercise" (? negligent).”

If medicine considers that the treatment of osteoporosis can be affected, good or bad, by any or all of these factors (which it does), then a responsible GP or specialist should provide this as part of their Hippocratic oath, I remind you that a modern rendition includes the following

“I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism. I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug……….I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability.”

“Were you to put these views to your doctor he could well initiate legal action. “

I have not suggesting taking legal action, as my interest is an improved health outcome for myself, not tilting at windmills as a legal path would become. Why do you even raise this? My objective is to improve my health not crusade against ineffective medicine, but it does not change my judgement of it.

“I completely accept that these are your strongly held views and I think it's awful that any doctor, albeit unknowingly, would have his patient in this state. You are obviously a very intelligent and resourceful woman and yet - here you are!  Does this doctor have a clue about your anger and concerns? If he doesn't, he should!  If he does, then get another specialist - NOT a GP . . . A GP knows a little about a large range of medical conditions and therefore is spread very thinly . A specialist knows a lot about very little. Both have a value. “

We are in violent agreement here. I have prior experience of doctors before this diagnosis of osteoporosis. I use multiple resources including this GP and specialist, and as noted in other posts on my osteo that you have perhaps missed, I have said this, I also use alternative practitioners. I don’t intend trying to reform these individuals or the medical system, but I can still vent my frustration on a forum of this kind – if that’s OK with you?

“I have worked in 4 major city hospitals over 37 years as a paramedic and it was plenty of time to form a view about the profession - from junior doctors to consultants. “ 

Respect. As a volunteer beach lifeguard, I know and have worked with a fair number of paramedics and am in awe of their ability to provide far better care than I can on the beach, it always a relief to hand over serious cases  to them. I have also had very positive experiences with some physiotherapists who have helped me recover from injury.

“Doctors are like any other workers:   

I've met lazy ones, ones I wouldn't consult, competent ones, world-class inspirational ones. I've seen those with total dedication to their patients - whose family life and marriages have therefore suffered badly, and those, who though very ill themselves, just kept working until the end. I'm sure we all know ordinary people like this also. “

No argument here either. My views are not as one dimensional as one post might suggest, yet even reading all my comments on this topic would not give complete insight into my past and current experience with health and medicine.

“However, I have never encountered a doctor who was in medicine for the money  - as those who practice other professions often are. To me, they genuinely want the best for their patients, though, of course, some of them fail abysmally in this. Your post vividly draws attention to this deficit.”

I currently know two medical student who are drawn by the money as well as the fact they have the brains to complete the study, just as I know others that do it as a calling. The difference from most other professions is the effect on the lives and health of their patients. I am aware that a moment of driving incompetence from anyone in any profession can cause a car accident with catastrophic consequences and I do what I can to avoid these as well.

“Finally, you said at the start of your post "I am trying to educate myself on my condition and how it should be treated". Are you saying you need to know more? Great. But becoming your own doctor, as it were, I think is a mistake - and an isolated place.  A half-way position would perhaps be to 'unearth' a really good specialist who has studied, and practiced, and supervised, and researched the area for decades.. . He HAS to know more than you at present and would be more than able to discuss your concerns and answer your probing questions. You never know, both of you may enjoy it !!”

You are inferring my thoughts here, my intention is not to become my own doctor but to retain ownership of my health and there is a critical difference. This includes leveraging expertise from multiple sources including allopathic GP and specialist as well as naturopaths. The objective in educating myself on the condition is not to replace medical expertise but to know enough to avoid following dangerous principles.

As an example, I am the father of identical triplets. This is a high risk pregnancy, we were told steroid jabs are the standard protocol to improve lung function for higher order multiple if born between 28-32 weeks. Concerned about the effect of steroids, we were told that any side effects were better than death due to inadequate lungs at premature birth. Through discussion with the gynae we discovered another way to avoid the jabs unless labor started. This standard protocol acted much like the theory of a flat earth. Everyone believed it because they did not bother to examine the underlying premises.

Finally, I am not a woman, I am not sure how this idea happened, but I certainly did not start any Chinese whisper.

Hi Kathleen

I also disagree with the specialist about the low importance he gives Vit D as a possible primary cause, however my own conclusion that its at least possible is based on multiple factors over many years and I am still putting it together. Prereqs like K2 that place Ca in the correct place, Mg etc etc, none of this was mentioned. I have had a range of blood/urine tests for Ca Mg Ph, etc hence why I am trying to understand what they mean. As you say, a normal level of Ca in the blood does not the bones are not being leached of Ca to maintain blood homeostasis. Its complex with many unknowns, there are conflicting medical views, and no one medico can hope to combine his knowledge with medicine with the specifics of any single patient to get optimum results. 

Apologies for wrongly identifying your gender. Maybe because most people with osteoporosis are women and older as well! Very few young people have osteoporosis so unless they state their age or gender I make assumptions.

 

Kathleen, no apology required, women are more affected than men by osteo for biological reasons, gender typing seems to be a normal reaction when we engage with others as a way to understand them. I have no issue being gender typed.

Hi tbully, What a brilliant response!  And thank- you for taking the time and effort to do so.

I won't begin to argue with any of it. 

My post to yourself came, not just from sympathy with what I saw as your own unhappy situation (though, that view has now happily changed), BUT also with what I often see on this particular forum as a kind of group 'mental set' against conventional medicine and it's approach to treatment of OP.

This I fear may 'tilt' some 'new arrivals' especially towards a situation where they may feel confident abut treating  themselves. 

EG. a person with severe OP and a history of fractures (and never keen on taking medication anyway) could decide that diet, supplements, and exercise alone will work for them. This could be dangerous. However the truth here is probably that all interventions have a value but that these lifestyle changes, while not doing ANY harm, may not be very effective either. - while medication really does work though some may suffer troublesome side-effects. 

Your earlier post acted as a catalyst, highlighting, as it does, the logical fallacy of arguing from the particular to the general Eg." My doctor was pretty inadequate in dealing with my OP so doctors are incompetent in this area"  or - " Diet, exercise and supplements caused a modest improvement in my bone density so this could be a treatment for all". Need I say, I fully accept that all views and contributions on this forum are sincerely and honestly held, but belief is not knowledge - for any of us. 

Finally, well done with your success in dealing with medical issues. AND I'm really sorry about the 'gender confusion'.      Kind Regards, J

 

For some reason I knew you were male.  I'm sure you must have mentioned it in a reply somewhere, and your reasoned logical approach to the topic and professorial vocabulary and mode of expression seems more masculine - sorry everybody, that is gender-typing, but it's true.  

Interesting segue, I am conscious most posters here are female, assume its due both to the way osteo affects more women as well as womens better use of forums on the topics of health (my assumption). Gendertyping is a politically sensitive topic, however it can blind one to the real differences between the sexes, and when trying to address health issue, the less we are distracted by politics the better.