Dear Dr. Roach: I鈥檓 a 57-year-old female, and I聽have osteoporosis. My average T score is -3.3. My L4 is -4.1. My doctors have told me that it is genetic and that calcium, vitamin D and estrogen are of no help. They have suggested that I try Prolia or Forteo. These medicines, as you know, are injectable and very expensive. My insurance company excludes Prolia. I鈥檓 writing you in hopes that you will have a suggestion for building bone a more natural way.
J.A.S.
The optimal treatment for osteoporosis depends on many factors, but the level of the T score is very important. A T score is a measurement of how much mineral there is in the bone (which is a fair estimate of how strong the bone is) compared with a healthy young woman (or man). A T score of 0 means you have the same bone mineral density as a healthy young woman, but the minus sign means less bone density. A T score below -2.5 means osteoporosis, and a score of-4.1 is very low, with a high risk of fracture (L4 is your fourth lumbar vertebra). That is why your doctors have wanted to use powerful medicines that act quickly. If your T scores weren鈥檛 so low, then you would have more options. I am a believer in natural treatments, when they have been proven to work (as in osteoporosis), but I think you really should consider medication as well.
It isn鈥檛 true that calcium, vitamin D and estrogen are of no help; in fact, they help a lot. Calcium is the essential mineral that needs to go into your bones, so you need to be taking in enough. Vitamin D helps your body absorb calcium and put it into the bones, so that also is critical. Estrogen is another treatment for osteoporosis, but because it increases blood-clotting risk and may have adverse effects on heart disease and breast cancer (in聽combination with progesterone), it is less frequently used, but sometimes is used聽either by itself or in聽combination.
I received a letter from a woman who is an instructor for an exercise program called Strong Women/Strong Bones, who reminded me to emphasize the importance of weight-bearing exercise to strengthen bones. Because of your very low T聽score, however, I would discuss with your doctor the聽best form of safe exercise.
Forteo is a 鈥渘atural鈥� product in that it is an analogue of parathyroid hormone, the body鈥檚 primary regulator of bone metabolism.
In a major study, Forteo reduced the risk of any vertebral fracture (which you are at highest risk for) from 14 per cent to five per cent. I聽think that a medication like Forteo, in combination with a good diet with plenty of calcium, supplemental vitamin D and exercise, is your best option.
