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I posted about this in my blog, but thought I'd throw it out here to see if I get a wider response.

I'm 38, and while I'm technically premenopausal, I haven't had a period since April 2010. My mother found out she had osteoporosis when she broke her hip at age 38. That prompted her four sisters to get tested, all of whom have it as well. Both grandmothers have/had it as well.

I just had a bone density scan done last week and got the test results last night. My T-score was -1.3, and my Z-score was -2.3. Apparently, my L1 was had significantly less bone mineral density than my other vertebrae. According to the report, the z-score should be used since I am pre-menopausal, and it indicates low bone density. If I was postmenopausal, my t-score would indicate osteopenia.

I am going to discuss my results and my options with my GP on the 1st. Ironically, I also have an appt with my OB\GYN on the 7th, whom I will discuss this as well.

My concerns are these: could the increased prolactin that my risperdal causes be contributing to this? I also have a progesterone-releasing mirena IUD, but my periods didn't stop until after I increased the risperdal to 6 mg. My prolactin level is 19 right now. I did some reading, and it seems a lack of estrogen, present in women who menstruate regularly, has a lot to do with bone density levels. I also have PCOS, and have never had a regular period in my entire reproductive life, though I've never went this long without a period.

Frankly, I worry that I will have to get off the risperdal. It's been a miracle drug for me, and I'm very stable on it, which took me years to get here. I also wonder if I need to resume some sort of hormonal treatment, or treatment for the PCOS.

Also, how bad is my score? I worry that I'm at as high of a risk of breaking a bone as my mother was at her age (I don't know her scores on her tests). Should I just take more calcium, excercise more, and stay at my status quo and simply get new dexa scans every year?

Who's the best person to talk about all this with? My GP, my OB/GYN, my pdoc? Obviously, if the risperdal is having an impact, then the pdoc's going to have to be involved. But who's opinion matters more on the bone density - the GP or the OB\GYN? And who would coordinate all the testing that has to be done? This seems like a logistical nightmare.

I'm in uncharted territory for me. While I'm not surprised by the results (remember, my family history), I do have a special set of circumstances that my other female relatives do not.

But maybe I'm just getting ahead of myself. Maybe I just need to have my supplements adjusted and my status monitored. After all, I did this testing so early so I wouldn't be caught off guard like my mother or her sisters.

Thanks,

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I don't know about Risperdal and prolactin, so I guess you will have to discuss that with your pdoc.

I think the bone density issue is one that your ob/gyn will know the most about, unless your GP sees a lot of post menopausal women. It's unfortunate, but a lot of GPs don't know much about nutrition and issues like the ones you're writing about----although your doc may be better informed.

Most gynecologists are the ones reading bone density tests, but in this case your ob/gyn needs to be informed about your Risperdal. S/he may want to do some research into your meds if he isn't familiar with the side effects. Anyway, I would tend to be guided by the gynecologist in terms of bone density questions. It also wouldn't hurt to encourage your ob/gyn to consult with your pdoc.

In the meantime, you can do all the good stuff you know is important for bone density:

1) If you smoke, quit as soon as you can.

2) Eat a calcium-rich diet.

3) Try to get outdoors for at least 15 minutes every day with NO sunscreen on your arms and legs.

4) Get your Vitamin D level checked, and take supplements if it is low.

5) Exercise! Walk, jog, swim, lift weights---do whatever you can to help your skeleton get stronger.

6) Watch the caffeine intake. (It interferes with the absorption of calcium into your bones.)

It may be that your genetics are causing this situation, and not the drugs you're taking, but I think you are smart to keep all of your doctors in the loop.

olga

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Osteopenia can be a side effect of Depakote, FYI. I don't know if you have been on it long enough. I was on it a total of about 6 or 7 years, and I am barely osteopenic, although, of course that might have happened anyway. But while there is some osteoporosis in my family, no parents or grandparents have had it.

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...and do not forget the growing body of evidence that links the consumption of carbonated beverages with leeching of calcium from the bones. As >>this<< article points out:

A 2009 study showed an association between regular intake of colas and negative effects on bone.

“This is not an area that is rife with evidence,” says Duke osteoporosis specialist Thomas Weber, MD. “We need more studies, but so far the data show that an excessive intake of carbonated beverages, especially cola, appears to have somewhat of a detrimental effect on bone health. There is potentially a biological basis: if the increased acid load from soda exceeds what the kidneys can take on, the body looks to other buffers, so bone is tapped as well.”

The body may attempt to neutralize the excess acid by using calcium culled from the bones.

Whether "proven" or not, it seems sensible to limit the consumption of diet drinks, especially with a marked family history of osteoporosis and a personal diagnosis of osteopenia.

Also, it could be helpful to request a referral to a rheumatologist. Rheumatologists specialize in bone health, including the diagnosis of osteopenia/osteoporosis, its treatments and prognosis.

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Thanks for the soda POV ladies. It's definitely something I need to think about

I'm going to discuss the rheumatologist with my GP on the 1st. She'd be the person to refer me, no matter what happens. So we'll see what happens after next week's round of appointments.

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I've got several health issues going on. What I do is make sure that my GP gets copied on every test and every report. I've got a great GP. She said that we're all on the boat together--me and the docs. She said that she'll be the captain. She isn't as knowledgeable about the specialties and she is very up front about that. What I need is someone that will look at the big picture, rather than just a little part. I was stressing myself beyond belief trying to figure out all the things on my own. Especially things like prolactin. I finally went to her and laid the whole thing out for her.

Today, I had a problem. I called her office. It was her morning to do paperwork and leave early. She saw me anyway. She said that she'd rather see me than me having to see whoever was on-call and everyone having to get up to speed. Getting a good GP that you can trust is so very important.

I was looking at the requirements for bone scans today. Granted, this is for my insurance but it's BCBS so it's pretty standard on things like this. You qualify for yearly scans from what I read. I can't specifically speak to your numbers but from what I understand you really need more than one scan to really tell what is going on.

A lack of estrogen will make a huge difference in your bone density. Did you get that level checked? I'm guessing with PCOS that your estrogen is low and your testosterone is high--if I'm remembering correctly. I'm thinking that you need some vitamin D along with the calcium. Don't they sort of help each other be absorbed better? Honestly, my mind is jello tonight. Talk to your GP. If he/she isn't able to coordinate all this for you then maybe consider finding another one. Or ask the doctor that you trust most what you should do.

Everything that was mentioned in earlier posts are really good suggestions. Take those. It's a really good starting place.

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