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.

15. Microarchitecture

On the left are the rail-less granite slabs that serve as steps leading away from my back door (the steps continue unseen to the left). This angle demonstrates the steep drop from the top step to the bottom of the window well outside a basement window, about six feet.  

So there I am on the that step, standing on one leg while I put on a shoe, when I lose balance and fall into the well.  It's a slow fall and I think as I fall, "shit, I'm probably going to break the window; a real pain to fix."

I should have been more worried about breaking me, given the state of my bones.  A few months later, the hinge on my folding bike breaks and down I go.  But again I remain unbroken. Many people with osteoporosis break a bone just standing up or sitting down. Why didn't that happen to me with two hard falls?

The answer may be a concept called microarchitecture.  I may not have density, but there is something protective about what little structure I do have.  Sounds like a theory made up to explain something that can't really be explained.  Whatever it is, I'm grateful for it.

14. Update

Now about half-way through the recommended 5 yr course of alendronate, which increases bone density.  Some studies have suggested that for the first five years, bone density increases, with minimal benefit thereafter but continuing (though very low) risk of side effects such as jaw osteonecrosis ("death" of jaw bone cells)--some dentists refuse to do oral surgery on patients taking alendronate.

Question:  when should I repeat a bone density test to see if the alendronate is working?  At least 2-3 years--got to give it time to work.  I'll probably wait for the 3yr option, and if no improvement consider alternatives.