The Story of My Left Hip (Osteoporosis and the medication to treat it).

Many of my patients, especially women over the age of 50, have been diagnosed with osteopaenia or osteoporosis. This has been determined by assessing T-score results from a specialised X-ray, known as a DEXA scan. As a result, these individuals have been advised by their doctor that they have low bone density, and could therefore have an increased likelihood of bone fracture, disability, or even an increased risk of death.

Indeed, it has been suggested that about one out of every two Caucasian women will experience an osteoporosis-related fracture at some point in her lifetime, as will approximately one in five men (Office of the Surgeon General (US), 2004). It is therefore not surprising that osteoporosis is responsible for two million broken bones and $19 billion world-wide in related costs every year (Sahni et al., 2015). Wow!  What statistics!  Imagine the future health costs on the individual and, with a growing baby boomer population over the age of 50, the burden on the country’s health system. Consequently, it would appear reasonable that we should do what we can to prevent this epidemic, and it makes perfect sense that doctors should be strongly encouraging their patients to take medication to slow the decline. In fact, many of my post-menopausal patients are taking osteoporosis medication, and most of them are taking it in the form of bi-annual injections.

I personally know what it is to fracture a major bone, the surgery, the recovery and the reduction in certain movements and motility endurance.  14 years ago I was dancing at a wedding overseas and fell on marble floor.  Unfortunately I was wrongly diagnosed with a bruised left hip and was encouraged to walk.  4 days and two chiropractic consultations later, I found myself in extreme pain and unable to move.  The pain was finally correctly associated with a break of the femur bone (a.k.a the thigh bone).  As the broken bone had become totally starved of blood and nutrients after 4 days, a hip replacement was necessary.  The surgeons overseas thought it was only necessary to give me a partial hip replacement due to my age.  However, 5 years later, in Australia, a total hip replacement was conducted, as a result of extreme arthritis in the area (owing to the titanium rubbing against my cartilage).

After the accident I was advised to have a DEXA scan, the results of which showed T-scores below the normal range. Accordingly, I was diagnosed with osteoporosis and strongly advised to go on medication, otherwise I would continue having fractures.  Something I really did not want. So, despite being someone, who for many reasons refuses to take medication, I was not willing to take the risk and put myself in the line of fire again.

I was firstly prescribed a drug known as Fosomax (which I will discuss in the next post).  There was no discussion as to the side effects of this medication, other than the possible gastrointestinal issues, which require the user  to take the drug on an empty stomach, and to not lie down for at least half an hour after taking it.

Not so long after starting this medication I started suffering from Reynaud’s Phenomenon (see photo).  This is a condition characterized by a reduction in the blood supply of the extremities, especially the fingers, and typically brought on by constant cold, vibration or emotionally-charged situations.  It leads to pallor, pain, and numbness of the affected areas, and in severe cases, gangrene. I discussed the association of the medication with the onset of this condition with my GP.  Although he did not think there was any connection between the condition and the drug , he changed my medication to Evista, which I was on for 5 years.  It appeared that I tolerated this medication well as I could not detect any side effects.

After 5 years, my T-scores were even worse.  My GP told me to stop the Evista and make an appointment with the endocrinologist.  In the mean time I researched what natural things I could do, and as a result embarked on an alkaline diet, high in non-processed foods, fruit and vegetables. While there is much controversy and not enough evidence to verify the application of such a diet for bone health and other conditions, it is thought that a diet loaded with acidifying foods, such as processed foods, cheese, meat, fish, shellfish, and grains, might disrupt the pH (a measure of acid/base balance) of the blood, which is tightly regulated at pH 7.35 to 7.45. As levels above 7.45 (alkalosis) and levels below 7.35 (acidosis) are potentially serious, the body has acid–base homeostasis mechanisms that generally ensure this does not happen.  One such mechanism is believed to involve the the increased production of osteoclasts (the cells which break down bone) and the consequent release of alkalising minerals, such as calcium and magnesium from the bone stores.  Over time this release reduces bone density (Carnauba, et al., 2017).  In fact, the authors of a 2016 review found supporting evidence from studies, that consumption of abundant alkaline-forming foods can lead to an improvement in bone mineral density (BMD) and muscle mass, protection from chronic illnesses, reduced tumour-cell invasion and metastasis, and effective excretion of toxins from the body (Mousa, 2016).

Although my diet was already a healthy one, I included more fresh salads with every meal and reduced the amount of grains and acidifying products. During this time, I felt that the diet was improving my health and felt fairly well overall.

Weeks later at the appointment with the endocrinologist, I was strongly advised  to resume taking Fosomax.  When I told her about the Reynauds, (which after testing was found to be linked to an autoimmune condition), she categorically stated that there was no evidence to suggest a link between the medication and autoimmune conditions.  So, like a good girl, I listened and went back on Fosomax.  While it was noted that my vitamin D levels were very low, the doctor did not seem to place too much importance on this, and just included 1,000 IU of vitamin D in my Fosomax prescription. (From my own experience as a patient and naturopathic practitioner, this amount of vitamin D is just not enough to bring values back to the normal range and to improve bone health).  She also did not believe I needed another vitamin D test for two years.

Unfortunately, soon after my endocrinologist appointment, my psoriasis, AN AUTOIMMUNE CONDITION, flared badly.  Usually I only experienced irritation in isolated patches.  But during this time, the psoriatic plaques were not only itchy but also highly inflamed and burning.  Also, all the said areas were affected at the same time (and I have many).  I was beside myself!!

A naturopath working in a health food store suggested that the cause of the flare-up could be the osteoporosis medication.  I remember sitting in my car, after the conversation, confused about what to do next.  After some thought I decided to stop the Fosomax for approximately 2 months, and see if that would give me relief. I hoped that this would be enough time to rid the body of any traces of the drug.  If the flare-up continued at the end of this period, this would reduce the probability of Fosomax involvement.  Soon after stopping the medication, my psoriasis improved markedly.

When I informed the doctor of this complication and solution, she grudgingly changed my medication back to Evista (remember that my bone density had worsened under this medication).  Again I listened.  Another interesting development followed:

During the 5 years I was originally on Evista, I developed an arthritic nodule on my right index finger (see photo).  I thought that this occurred as the result of the normal ageing process, and although very painful, especially at night, I did not link it to the drug.  However, interestingly, in the time period that I was not taking Evista, the pain completely went away.   A few days after resuming the drug, my finger became inflamed and very painful again.  One morning after a particularly bad night, I discussed with my husband the possible link of Evista to the pain, and he suggested that I stop taking the medication temporarily to see if the pain would subside.  Which it did!!  And, many years later I have not had any pain or any development in the condition, despite the nodule still being there.  Imagine, if I had not had that interim period where I was not taking the Evista, I would not have linked the arthritic condition with the medication, and would most probably have painful nodules on all my fingers.  Does this not raise the question of whether arthritis is primarily due to normal wear and tear of the joints, or as a result of prescribed medication?  Most elderly people are taking many drugs, and most suffer from some form of arthritis?  Are they linked?

While my next post will include more details on osteoporosis, T-scores, DEXA scans and mechanisms of osteoporotic medication, I wanted to alert you that you could have chronic health issues that might have been triggered by medication used to treat this bone condition.  Sometimes the onset is so subtle, and comes on so gradually, that you don’t put two and two together. You just think that it is bad luck, or ageing, or stress (which still might be contributors).  In my practice I have noticed a trigger to most chronic conditions, and  very often, it can be associated with the timing of a new medication.

Accordingly, while this post is not meant to say whether or not the drugs commonly used to treat osteoporosis are effective in improving bone density and fracture rate, it is meant to stimulate discussion and thought.

Here are some questions that you might ask yourself?

If you are taking medication to improve your bone density, do you

What about bi-annual/annual injections (e.g. Prolia)?

 Normally when you feel that a drug could be causing certain adverse effects, you stop taking it.  However, what do you do if you had a 6-monthly injection and you associate the onset of some health issues soon after the timing of the stab?  Does that mean you will have many more months of suffering until the drug is out of your system? Furthermore, when there is an intake of a foreign substance, drug or chemical, it is usually done by the oral and digestive system route, where there is a sophisticated innate immune system to ensure that the body is protected.  What happens when this route is bypassed, and the substance is directly injected into the blood stream?  Will the body still get the same protection?  Or is this a further area for concern? If you are determined to take medication to improve your bone density, wouldn’t a tablet or capsule make more sense?

Another issue with bi-annual or annual injections, is that the patient has forgotten about them. They often fail to list it as a medication on an intake form, and do not link any health issues with the injected drug.

If you have any concerns, please, please, discuss this with your doctor.  Ask him/her what the potential side effects are. Don’t think you are being silly for raising it, and don’t allow the doctor to dismiss your concerns. You are the boss of your body.  You instinctively know what works and what doesn’t.  So,  if you believe there is a link, despite your doctor saying that there is no evidence for the association, do not back down.  Of course, once you are armed with the information, you, and only you, must decide whether the risks outweigh the benefits.

Please don’t hesitate to leave your comments.  I realize that these are my personal experiences and you may have a different story to tell.  Perhaps, you have also experienced side -effects, or conversely, have had good outcomes, from taking these medications.  We would love to hear from you.

If you can relate to this article, and need some assistance, please do not hesitate to contact me.  Also, if you have still not read my other blogs, please click here. Furthermore, I have a facebook page that not only shares some of my blogs and videos but provides valuable health information.  If you gain insight from some of the contributions, don’t forget to click on the “Like” button.

Carnauba, R. A., Baptistella, A. B., Paschoal, V., & Hübscher, G. H. (2017). Diet-Induced Low-Grade Metabolic Acidosis and Clinical Outcomes: A Review. Nutrients, 9(6), 538.

Mousa, H. A. L. (2016). Health Effects of Alkaline Diet and Water, Reduction of Digestive-tract Bacterial Load, and Earthing. Alternative Therapies in Health & Medicine, 22.

Office of the Surgeon General (US) (2004). Bone health and osteoporosis: a report of the Surgeon General. Retrieved from: http://www.ncbi.nlm.nih.gov/books/NBK45513/.

Sahni, S., Mangano, K. M., McLean, R. R., Hannan, M. T., & Kiel, D. P. (2015). Dietary approaches for bone health: lessons from the Framingham osteoporosis study. Current osteoporosis reports, 13(4), 245-255.