I am interested in when a woman should have a bone density scan to test for
osteoporosis? I am entering menopause and trying to decide whether to take HRT.
When I asked my doctor about having a bone scan to check bone density, she said
it was too early to tell anything. Is this true? She said I should wait two or
three years and then have it.

I don't really want to take HRT but if a scan was done and showed accelerated
bone loss, I would take it. Can anyone out there tell what the best choice is
here?
Thanks in advance.
Donna Sullivan

I am also wanting to have a bone scan.  I got the impression it was sort
of like having a baseline mammogram. What good is it to have the bone scan
long after the damage is begins? Up until your post, I figured my biggest
hurdle was how to pay for it, not finding a doctor who would do it! I am
still having semi-regular periods but there have been many signs of the
reduction of estrogen which I can see...bone density I can't see.  Anyone
know what they do to perform this test?

Noel Gilmore

: I am interested in when a woman should have a bone density scan to test for
: osteoporosis? I am entering menopause and trying to decide whether to take HRT.
: When I asked my doctor about having a bone scan to check bone density, she said
: it was too early to tell anything. Is this true? She said I should wait two or
: three years and then have it.

: I don't really want to take HRT but if a scan was done and showed accelerated
: bone loss, I would take it. Can anyone out there tell what the best choice is
: here?
: Thanks in advance.
: Donna Sullivan

I would get a scan done, it would give you an idea of your initial bone mass.
If it is already in the lower range for your age group I would say, go for
the HRT. If you're in a high risk group (underweight, sedentary, smoker,
take steroids for another condition etc), then I would say take it
regardless.

Once the bone has gone, there is virtually nothing that can be done to
replace it and I have seen my mother suffer ver badly from it.

On the other hand, if your family has a history of {*filter*} cancer, you might
want to avoid HRT.

Excercise (load bearing), not smoking and eating a good diet will help to
maintain your bone density, whether or not you take hormones.

Good luck
Debbie

P.S. I am not an expert on this subject - this is all from family experience
and my reading.

--
---------------------------------------------------------------------------

Rheumatology Research Unit, Addenbrookes Hospital, Hills Road, Cambridge, UK.
----------------------------------------------------------------------------
        I never could get the hang of Thursdays   (A.Dent).

If you exercise your muscles they grow stronger quite quickly. If you
exercise your tendons they too grow, but a lot more slowly. It is
certainly the case when young that loading the skeleton with the
forces produced by larger muscles does in time increase not only the
bone density but also the bone size to withstand the forces. It is
also the case that suddenly removing stress from bones, as happens to
astronauts who do not exercise, results in dramatically rapid bone
loss.

Is it really the case that there is a particular age at which this
natural ability of the skeleton to adapt to the use put upon it is
capped by an inability to increase mass? The statistics which suggest
that this is the case are just as well explained by the hypothesis
that the skeleton does not lose this ability, but that the average
aging person is also becoming less and less active, and the skeleton
is simply responding to this. Support for this view is provided by the
fact that sedentary people are most at risk from osteoporosis.

The two questions I would like to see answered is this: is there any
evidence that load-bearing exercise in later life *cannot* increase
bone mass? There *is* evidence that exercise retards the loss; is
there any evidence that even more exercise will actually reverse the
loss?

Anecdote: a woman secretary at the age of 35 had a nervous breakdown,
was diagnosed a schizophrenic, and hospitalised. She remained in
mental hospital for the next 20 years, and became frail and feeble.
She was allowed out in the company of trusted friends at the weekend
(my mother was one) but found a walk of more than a couple of miles
exhausting. Of course medication may have contributed to this.  She
twice broke an arm falling on stairs in the hospital, which I took to
be a sign of osteoporosis.  Then, at age 55, a change of Govt policy
to "care in the community" released her. She was still pretty dotty,
and believed lots of strange fantasies. Unemployable, trying to live
off meagre state welfare, she took to cycling and growing her own
garden vegetables to save money. She was left some small scattered
properties by dying friends, to provide her with an income. She let
them, and cycled round them every week summer and winter to collect
the rent and check that the tenants were behaving properly. The
furthest was 12 miles away from her home.  By the age of 65 she had
become as strong as a horse, with sturdy athletic arms and legs that
many 30 year olds would be proud of.  Regularly once a month, on an
ancient heavy utility bike with a wicker shopping basket on the front,
she cycled 45 miles to visit a friend, stayed overnight, and cycled 45
miles back. If it rained she donned the raincoat she kept in the
basket, along with puncture-fixing tools and a bottle of tap water.
She had the odd bike accident, shrugged them off as "only cuts and
bruises", but never broke any more bones. This I took to indicate that
she longer suffered from osteoporosis.
--

Department of Artificial Intelligence,    Edinburgh University
5 Forrest Hill, Edinburgh, EH1 2QL, UK                DoD #205
"The mind reigns, but does not govern" -- Paul Valery

: >Once the bone has gone, there is virtually nothing that can be done to
: >replace it and I have seen my mother suffer ver badly from it.

: >Excercise (load bearing), not smoking and eating a good diet will help to
: >maintain your bone density, whether or not you take hormones.

: Is it really the case that there is a particular age at which this
: natural ability of the skeleton to adapt to the use put upon it is
: capped by an inability to increase mass? The statistics which suggest
: that this is the case are just as well explained by the hypothesis
: that the skeleton does not lose this ability, but that the average
: aging person is also becoming less and less active, and the skeleton
: is simply responding to this. Support for this view is provided by the
: fact that sedentary people are most at risk from osteoporosis.

True, your skelton does not lose the ability to adapt, but it becomes less
effective at it. Bone is not static, it is continually being degraded and
replaced. After the age of 35 (approx) the balance of synthesis and
degradation tips such that bone is slowly lost for the rest of life.
Why this happens is not known. Exercise helps to tip the balance back again,
but generally only a small percentage increase in bone mass will be seen
for an older person.

Unfortunately when a person is in the situation of extensive bone loss (25%
or more), exercise is difficult, they may be in severe pain and doing any
exercise puts them at risk of fracture - catch 22 situation.

: The two questions I would like to see answered is this: is there any
: evidence that load-bearing exercise in later life *cannot* increase
: bone mass?

As I said, it can, but not much (drug treatment i.e. with bisphosphonates
can also increase mass slightly)

 There *is* evidence that exercise retards the loss; is
: there any evidence that even more exercise will actually reverse the
: loss?

: Anecdote: a woman secretary at the age of 35 had a nervous breakdown,
: was diagnosed a schizophrenic, and hospitalised. She remained in
: mental hospital for the next 20 years, and became frail and feeble.
: She was allowed out in the company of trusted friends at the weekend
: (my mother was one) but found a walk of more than a couple of miles
: exhausting. Of course medication may have contributed to this.  She
: twice broke an arm falling on stairs in the hospital, which I took to
: be a sign of osteoporosis.  

The exhaustion probably was due to medication. Falling downstairs whilst
doped up is not unsurprising and if you are dopey then perhaps you would
fall more awkwardly... Simply breaking a bone is not necessarily a sign of
osteoporosis, but it should have been checked out if she was post-menopausal.

Then, at age 55, a change of Govt policy
: to "care in the community" released her. She was still pretty dotty,
: and believed lots of strange fantasies. Unemployable, trying to live
: off meagre state welfare, she took to cycling and growing her own
: garden vegetables to save money. She was left some small scattered
: properties by dying friends, to provide her with an income. She let
: them, and cycled round them every week summer and winter to collect
: the rent and check that the tenants were behaving properly. The
: furthest was 12 miles away from her home.  By the age of 65 she had
: become as strong as a horse, with sturdy athletic arms and legs that
: many 30 year olds would be proud of.  Regularly once a month, on an
: ancient heavy utility bike with a wicker shopping basket on the front,
: she cycled 45 miles to visit a friend, stayed overnight, and cycled 45
: miles back. If it rained she donned the raincoat she kept in the
: basket, along with puncture-fixing tools and a bottle of tap water.
: She had the odd bike accident, shrugged them off as "only cuts and
: bruises", but never broke any more bones. This I took to indicate that
: she longer suffered from osteoporosis.

Unfortunately osteoporosis once present doesn't go away, even with a change
in lifestyle. What this lady is doing is great for helping herself, but if
the disease is present it may yet manifest itself, say in a decade (although
I hope it was never there in the first place - for her sake).

: Department of Artificial Intelligence,    Edinburgh University
: 5 Forrest Hill, Edinburgh, EH1 2QL, UK                DoD #205
: "The mind reigns, but does not govern" -- Paul Valery

I read a rather worrying pice in the paper yesterday about the extremely
low numbers of women taking suitable exercise - maybe the message will get
across eventually...

Debbie

--
---------------------------------------------------------------------------

Rheumatology Research Unit, Addenbrookes Hospital, Hills Road, Cambridge, UK.
----------------------------------------------------------------------------
        I never could get the hang of Thursdays   (A.Dent).

Most people, whether athletic or sedentary, become less active after
35, which is consistent with my hypothesis.

As my hypothesis suggests.

Which is consistent with my hypothesis, given the fact that after 35
very few people change lifestyle to the extent of making considerable
increases in strength.

She was post-menopausal, and wasn't checked for osteoporosis. Breaking
a bone is not necessarily a sign of ost., but given that it is very
rare to break an arm (rather than a wrist or collarbone) in a stair
fall, and that she did it twice, it is definitely suggestive.

I cited this example, because this case is most unusual in that a
frail post-menopausal woman changed her lifestyle to such a degree
that she increased her muscular strength and endurance very
considerably indeed. That is the kind of test case which could
differentiate between the conventional medical wisdom (after 35 only
slight increases in bone mass are observed, we don't know why; and
osteoporosis cannot be recovered from, only slowed down, again we don't
know why) and my hypothesis, which explains these observations
equally well, but suggests a different outcome in this rare and
extreme kind of case.

So the astronauts who suffered massive bone loss while in orbit,
including the unfortunate Russians who lost so much bone that they
died of multiple fractures simply under the force of normal gravity on
return to Earth, were not suffering from osteoporosis, since their
losses, if not so large as to be fatal, were recoverable? If so, what
is the important difference between this kind of bone mass loss, and
osteoporosis, which makes it unrecoverable?

--

Department of Artificial Intelligence,    Edinburgh University
5 Forrest Hill, Edinburgh, EH1 2QL, UK                DoD #205
"The mind reigns, but does not govern" -- Paul Valery

writes:

In the United States, it may be even worse -- most studies of diet
indicate that on the average US women get only about half their daily
requirement of calcium. At those levels of calcium the women will be
suffering bone loss even *with* enough exercise.

The original post concerned HRT (hormone replacement therapy). There are
two significant objective health benefits from HRT: reduced rate of bone
loss, and reduced risk of heart disease. Post-menopausal women should
discuss all of the health risks and benefits from HRT with their doctors.

Mark Brandt, Ph.D.