22. Five years

Five years is the usual course for alendronate, the drug that dampens the enthusiasm of osteoclasts, the bone cells that dismantle bone structure, a process followed by osteoblast remodeling/rebuilding.  Why just five years? Well, there are side effects--gastritis, osteonecrosis of the jaw, possible increase in femur fractures, all very rare but harder to ignore with each passing year.  Also, the effect of alendronate lingers, so my osteoclasts remain inhibited--or so they say.  But before deciding whether to continue alendronate or perhaps consider other approaches, some form of assessment is in order.  A bone density test obtained two years after the start of alendronate showed marked improvement; let's see if that progress has been maintained. \

21. Bucket List

It was one my bucket list, I explain, when I'm asked about the cast on my left forearm (non-displaced distal radial fracture). I've never broken a bone before, but you'd think that with osteoporosis, I'm at risk.  OK, but how much risk?  Well, not that much.

The FRAX algorithm uses bone density measurements and also family/personal history and height/weight. FRAX says over the next 10 years I have a 10% risk of a major osteoporotic fracture (which includes my broken wrist) and a 2.5% risk of hip fracture.

That's a fairly low risk, but for me it was 100%.  

So I do anything about it?

As planned I will continue the alendronate for the five year course.
And I will continue HCTZ which diverts calcium from urine to bones.
I should step up my self-designed yoga routine which emphasizes balance, core strength, and posture, the first two particularly important for fall prevention.

And of course, more caution when pruning tall trees

20. Annual Exam 2017

Met with my endocrinologist who who agree with the plan to continue alendronate for another couple of years.  She was not surprised that my bone density improved, both because that is not an uncommon finding with alendronate (despite official statements to the contrary) and because the HCTZ may be shifting some calcium to my bones.  The latter would also explain no new kidney stones.

19. Success!

Three years into alendronate therapy (the bone strengthening pill), I repeated the "DEXA" (bone density) scan of my spine, neck of the left thigh bone, and total hip.  The spine was the most affected before (3.8 standard deviations from the normal of a mature adult), and remains osteoporetic now--BUT ONE STANDARD DEVIATION BETTER!--only 2.8 SD.

At 5-9 and a fraction, my height is right at the mean of the American male.  If I were 3.8 standardard deviations below the mean, I would be about 4 ft, 10.5 inches.  2.8 SD would be around five foot, one and a half inches.  So taking alendronate for three years has been the equivalent of adding about three inches to my height (actually 2.8 inches). Not bad.

The plan is to continue taking alendronate for 2 years, then stop.  Somehow the bone densifying effect of alendronate continues long after stopping.  And continuing would increase the risk of jaw necrosis or spontaneous femur fractures that are rare side effects. Five years seems to be the Goldilocks balance between risks and benefits.

18. Osteroporosis by xray

Here are some computerized xrays (CT or CAT scans) of osteoporetic vertebrae (normal on left, osteopenia in middle, real-live osteoporosis on right).  No wonder they break (but why hasn't mine?). 

Impressive, eh?

17. Boring

I did get a call to come in. I thought about if for a few days, not really thinking it was necessary, but then again why not. First some "upper and lower abdominal X-rays, then a call from the urologist.  I had a regular appointment later that day, but he said a phone call should be sufficient since the X-ray showed no changes, as long as I was feeling okay, no need for further evaluation/treatment.

The X-ray showed : "abnormal calcifications: The evidence of bilateral nephrolithiasis appears stable on this exam.  No calcifications identified in the course of the ureters.  Bones: Mild degenerative change lower lumbosacral spine."

So, the stones are in the kidneys, just where the ureters take off (the "renal pelvis"), not in the ureters.  And the doc observed, the stones are small enough so that if they did enter the tubes (which would require a little uphill travel), they be able to pass (instead of obstruct). 

As for the spine, the previously noted arthritis, apparently not worse than on prior exams, and no side mention of osteoporosis, which had started the whole process three years ago.

16. Yearly Check-up?

A year ago I got a call from my urologist's office suggesting that I come in for an xray, which as I noted in post 13, showed no changes (no new stones and no change in the position of the pre-existing stone on the left).  

This year no such call, and I have been without symptoms of stones, so I'll let things pass.  I suppose that if were imaging to happen, and it showed movement of that left stone, it could be removed before it caused any problem--acute kidney stones aren't just the cause of pain, but can damage the kidney as urine builds up behind the stone.

Still, though, let sleeping dogs or stones or babies lay.