Aging, Bone Density, & Choices that Might Prevent or Cause Broken Bones

Bone density, an indicator of one’s predisposition to bone fractures, can be measured by a DEXA Scan. I had my latest DEXA scan on 12/11/23. In the first call from my doctor’s nurse, he simply stated that there had been an increase in my bone density since my last test two years ago, so I should keep taking every-6-month Prolia shots. Unlike my usual “do-what-the-doctor-says” self, I replied that I refused to continue the shots and explained my reasons.

After reporting this to my doctor, the nurse told me she said to do nothing until my next appointment in April when I could talk to her about my decision.

Do not consider this medical advice! It’s just an account of what led me to that decision—for now. Here’s some background. After age 35, most people start to lose bone density, which can lead to a diagnosis of “low bone mass,” Osteopenia, or Osteoporosis, which make bones more porous and easily broken. Women over age 65 or past menopause and men over 70 are more likely to have bone loss that can cause concern and call for a DEXA scan. But there are factors other than age that are considered:

• You break a bone after age 50.
• You have symptoms of osteoporosis, like getting shorter.
• You have a family history of osteoporosis or fractures. [DEXA scans weren’t available until 1987]
• You smoke, drink alcohol excessively, or use certain medications like steroids or cancer treatments.

There are various ways to maintain or improve bone density and prevent fractures, and not all of them involve a prescribed medication with its possible benefits and risks. They include:

• Exercise. Regular physical activity that includes exercises that are weight-bearing and improve balance and posture can strengthen bones and reduce the chance of a fracture. The more active and fit you are as you age, including maintaining your ability to balance, the less likely you are to fall and break a bone.
• Eat a healthy diet. Ensure you're getting enough calcium and vitamin D by taking supplements as needed and recommended by your doctor.
• Quit smoking. Smoking cigarettes speeds up bone loss.
• Limit alcohol. If you choose to drink alcohol, do so in moderation.
• Follow strict fall-prevention protocols.

What I’m doing

I exercise for about an hour five days a week. My routine includes weight-bearing, balance, stretches, back & hip strengthening, and 20 minutes on either my treadmill or stationary bike. I take daily calcium and vitamin D3 supplements as prescribed by my doctor. I limit my sugar intake, and I’m not overweight. I’ve never smoked, and I choose not to drink any alcohol.

How DEXA Scan results are reported

Bone density scores are based on comparison to younger individuals (T-Score) and age and sex-matched individuals (Z-Score). Here’s the breakdown:

• Normal: T-Score -1.0 and higher         Normal: Z-Score 0, or the same as others your age
• Low bone mass/osteopenia: T-Score -1.1 to -2.4          Lower bone mass: Z-Score -1 to -2
• Osteoporosis: T-Score -2.5 and below           Osteoporosis (not from aging): Z-Score -2.5 and below

My results

Most Utah healthcare systems allow you to access test results online. I got my results from the facility that performed the test and not my doctor. I had slightly different results for the parts of my body that were scanned. My T-Scores were between 2.1 to -1.8 and my Z-Scores were between 4.8 and 0.5. The summary or “Impression” was : Low bone mass or (my interpretation) in the lower-risk range of the T-Score for Osteopenia, sometimes referred to as Pre-Osteoporosis. My doctor will probably say that the scores were that good because of the Prolia shots. Point taken but read on.

Bone Structure in Osteoperosis

Medications usually prescribed first

Bisphosphonates are usually the first choice for osteoporosis treatment. They include:

• Alendronate (Fosamax), a weekly pill
• Ibandronate (Boniva), a monthly pill or quarterly intravenous (IV) infusion
• Zoledronic acid (Reclast), an annual IV infusion

I had been on and off Fosamax pills for 20 years, no questions asked. Of course, we didn’t have A.I. then. I have never been told I have Osteoporosis, only low bone density or Osteopenia. My current doctor who specializes in geriatrics put me on Prolia shots about 2 years ago. She told me nothing about the possible side effects or risks, only that she thought they might do more to improve my bone density than Fosamax.

Benefits, side-effects/risks

I started asking questions when I discovered that the pre-insurance cost of a Prolia shot is $1,624.54 per injection every six months according to one source and as much as $6,000 according to another. Even though I was only paying $39.00 per shot after Medicare and my supplemental plan did their part, I got mad. We all pay for Medicare benefits one way or another. That seemed a very high price for anyone to pay for a small percentage of increase in bone density, especially when I discovered what the serious side effects or risks could be. I am not making these up. Check what the manufacturer says by clicking here: Prolia’s Medication Guide.

Even if, as they say, the side effects are rare, I don’t want to take any chances on these:

• Bone, joint, or muscle pain. (I already have pain from arthritis.)
• Unusual thigh bone fractures. (My sister, a nurse, knows someone who had both thigh bones fracture due to treatment for osteoporosis.)
• Increased risk of broken bones, including broken bones in the spine after stopping skipping or delaying Prolia.

So bottom line, because I’m stopping Prolia I’m at greater risk for broken bones in my spine and elsewhere than if I had never taken it. I should have been told that I would have to take this drug for the rest of my life or face possibly serious consequences! “When stopping Prolia, bone turnover increases to above-usual values 9 months after the last dose. ‘Bone turnover’ refers to how quickly your bones replace old bone tissue with new bone tissue. Bone turnover takes about 24 months after the last dose of Prolia to return to a typical rate.” Prolia Side Effects: Common, Mild, and Serious (healthline.com)

The Takeaway

Of course, you should talk to your doctor. You can find a comprehensive list of questions to ask here: Osteoporosis Symptoms and Diagnosis (everydayhealth.com). Of course, your health risks for taking or not taking any medication for low bone density are different from mine. I just hope you will ask questions and make an informed treatment decision.

I blame myself for not asking more questions both many years ago when Bisphosphonates drugs first came on the market and I was prescribed Fosamax as a preventative medication, and again two years ago when I was prescribed Prolia shots. In April, I am sure to have an uncomfortable conversation with my doctor about how she wouldn’t prescribe anything unless she thought the benefits outweighed the risks, and about the risks I will be taking if I don’t follow her advice. I think I'll still feel the way I do today and take my chances.

 

Blog Search