T Nation

Help for Osteoperosis


#1

Hi

This is a long post, but I want to make it clear how much I have gained from T-Nation and lifting weights. I don't want to be discussing this with doctors without having some idea of what my true options are. I suspect I'm going to be told to stop lifting and I don't want to do that, so I need counter arguments and options.

I'm seeking any useful suggestions and or success stories for dealing with the seemingly bad results of a DEXA scan.

Medical history:

42 years old, male, 5' 3.5" tall, weight 163 pounds, about 24% bodyfat.

After several years of increasing illness, I was diagnosed with Crohn's disease in late 1997/early 1998.

From 1998 until 2002 I was on prednisone in doses typically from 20 mg/day to 60 mg/day with peaks during hospitalizations at well over 100 mg/day. I've been hospitalized 4 times for a total of about 40 days. I've spent several years between bedridden and barely able to walk.

In 2002 I was hospitalized 3 times for a huge abscess with a total of 30 days in the hospital. I hadn't been able to eat at all before that, and I entered the hospital at about 130 pounds. I was wearing pants and such left over from when I was in high school.

Even though I wasn't allowed to eat any food (just IV glucose), I gained over 100 pounds during the 30 days of hospitalization. By the time they sent me home I was unable to walk from my bed to the bathroom. I was so fat that I was completely unrecognizable.

I was on IV antibiotics every 8 hours and had a drain stuck in my back for most of 2002. Eventually I was started on Remicade for the Crohn's.

After the Remicade started helping, I started reading about fitness on the web.

I wanted to be strong and wanted to be healthy.

Many of the bodybuilding references to fighting inflammation seemed similar to suggestions made for Crohn's disease. Cut sugars, add fish oil, etc.

It was difficult as a fat lump who could barely walk to tell my wife (now ex) that I wanted to devote some of our meager funds and floorspace to exercise equipment. I was still sick most of the time, so exercising at a gym was impossible -- even just going shopping was difficult.

To understand my progress, on Oct 2, 2003 I did dumbbell squats with just the dumbbell handles (a total weight of 10 pounds) -- I managed a few sets of 10.

I've had a few major lapses in working out over the years due to a rotator cuff tear, a car accident with a broken rib and a bunch of herniated discs, and more recently some serious breathing difficulty/panic attacks. I was able to start working out again this summer.

On Oct 20, 2008 I did 5 sets of 5 squatting 195 pounds.

While that may not be the most impressive numbers to the healthy population, for someone who still remembers being in my 30's and unable to walk to the bathroom -- it feels fantastic to achieve that.

I credit a lot of my progress to the articles and inspiration I've gotten from this site.

I've found that intense exercise as often as possible does a lot for reducing the Crohn's symptoms. Looking back, it's probably how I kept myself from being disabled by Crohn's in high school and college -- since even back then I had many of the symptoms.

I currently lift weights 3 days a week and another 3 days I do a intense elliptical session followed by chinups and dips and whatever other exercises I feel like doing. The more I exercise, the better my overall health has been.

Being sore to the point that it's difficult to walk usually makes me laugh -- it's so much better than the alternative of being too ill and too weak to walk.

Unfortunately, my back started to hurt really bad after that October workout. Comparable to the broken rib from the car accident. My GP didn't think I could have broken a bone since there wasn't any noticeable impact.

When I discussed it with my gastroenterologist, he suggested an x-ray and a DEXA scan anyway. The x-ray showed no broken ribs.

The DEXA scan showed osteoperosis. At least that's the word my gastro used. The faxed results were sent to him on November 18, and he just told me this Friday. All my gastro would say is that he doesn't treat osteoporosis -- he wouldn't even let me see the actual results that say "high risk of fracture" while discussing it with him. I thought he should have something to say since prednisone induced osteoporosis is apparently common, so he must be causing this kind of problem all the time with Crohn's patients.

The actual fax says
The L4 vertebral body is in the osteopenic category.
Both femoral necks are in the osteopenic category.

I'm not sure of the difference between osteoporosis and osteopenic (if there is any).

I have a appointment scheduled with my GP tomorrow, but I'd like to have some suggestions as to what to say. I suspect she's going to suggest I drop lifting and just take up walking instead.

I get that a lot from doctors who see how I'm getting leaner and more muscular and feeling more healthy -- and so they suggest I stop lifting weights as if that must be the thing that's holding me back.

I do not want to stop lifting weights, but I have no idea how to weigh the risk factors. The max I've squatted was 212 and I've trap bar deadlifted 330 a while ago and I suspect I'm stronger now, but I don't want to load up a squat and have my spine shatter.

I've searched on the web for osteoporosis and come up with the suggestion that "resistance training is good" but they seem to consider things like walking and lifting cans of soup to be resistance training. I consider deadlifts with over 200 pounds to be resistance training. So I'm not sure if that's what they're talking about.

here's what the results say:

AP Spine L4
BMD 1.114 g/cm2
t-score -1.2
z-score -1.0

AP Spine L1-L4
BMD 1.154 g/cm2
t-score -0.7
z-score -0.5

dualfemur neck left
BMD 0.784 g/cm2
t-score -2.2
z-score -1.7

dualfemur neck right
0.757 g/cm2
t-score -2.4
z-score -1.9

What freaks me out is the following text, which I don't know how to interpret in regards to lifting weights:

BMD as determined from AP Spine l4 is 1.114 g/cm2 with a t-score of -1.2 is considered moderately low. Fracture risk is moderate.

BMD as determined from femur neck left is 0.784 g/cm2 with a t-score of -2.2 is low. Fracture risk is high.

BMD as determined from femur neck right is 0.757 g/cm2 with a t-score of -2.4 is low. Fracture risk is high.

I've found a few threads that mention the word osteoporosis, but would appreciate anyone that could provide any additional info since as far as I can tell, my problems come from the steroid prednisone and not from low testosterone.

http://www.T-Nation.com/free_online_article/sports_body_training_performance_steroids_drugs/steroids_for_dummies_1
says:
The other side of the coin would be steroids that bind to the AR slightly, or not at all. I think most of these steroids exert their effects by inhibiting the effects that glucocorticoids have upon muscle tissue. In other words, they prevent glucocorticoids from increasing glutamine synthetase and causing muscle tissue breakdown. This would be an anti-catabolic activity. This inhibition of glucocorticoids? effects may explain why most anabolic steroids work fairly well in the treatment of osteoperosis, since glucocorticoids can have influence or cause osteoperosis.

I know that prednisone is a glucocorticoid. Mostly though, this paragraph goes over my head. Does this mean that anabolic steroids might help me undo the damage to my bones? Or only if it was caused by low T?

http://www.T-Nation.com/free_online_forum/diet_performance_nutrition_supplements/personal_experience_with_cissus

Talks about Cissus and mentions osteoporosis, but I've never heard of Cissus before.

http://www.T-Nation.com/free_online_forum/sports_body_training_performance_bodybuilding_senior/reducing_shbg

Is someone diagnosed with osteopenia from having low testosterone.

While I suppose it is possible I have low T (I've had so many other medical problems at this point)

  1. I don't think I FEEL like I have low T.
  2. Years of prednisone use would be enough to explain the problem.

Should I be requesting some sort of testosterone level test just in case?
If so, what should I request?

Thank you for any help, suggestions, encouragement you can provide.
I had hoped that I was finally past medical nightmares for a while, and this is opening up a whole new set of problems. I can't even guess at the ramifications of "fracture risk is high".


#2

Ask your GP to refer you to an Endocrinologist for a proper workup for secondary osteoporosis (which would include testosterone levels as well as thyroid levels). Osteoporosis is treated by both Rheumatology and Endo, but, IMO you'd be better off with Endo.

Also, check the cred of the tech who performed the DXA. Improper positioning can dramatically affect your T-Scores - most states do not require any certification for techs and if the DXA is done at a hospital, typically it's a rad tech doing the scan (with little to no training). Good luck.