Bone Density Blues
A few years ago when I was recovering from knee surgery in the hospital, my surgeon told me that he was concerned about what he saw with my bones, that they were soft and powdery compared to normal bones. While it was important information, I have to admit that it shook me deeply in my overly-exhausted, pain-ridden, and drugged state.
During my childhood I drank milk and my mother reinforced how important it was “for strong bones.” But between my aggressive rheumatoid arthritis and years of prednisone, my bones have not held up the way I would like.
In fact, I was on Fosomax for supporting bone density—during my college years. Yes, college! The years I spent on the drug, along with calcium supplements, seemed to have helped for a while as my bone density results improved.
But as I have aged and gained artificial joints, it has been hard to tell how my bones are doing. Every few years I have a bone density scan on my spine (which thankfully looks good), but I’m really not so sure that all my bones (especially small ones like my wrist and ankles) are holding up.
Maintaining bone density is a very tricky problem. Women start losing bone density as they approach their 40s, which is another concern for me as I reach that milestone. But additionally I have an aggressive disease that attacks my bones and take medicine (like prednisone) that is known for weakening bones.
Another complicating factor is that besides diet (such as calcium and other vitamins and minerals) to support bone health, weight-bearing and exercise also contribute to the density and strength of bones. Due to the severity of my RA damage, I spend a lot of time in a wheelchair and my exercises are geared toward not putting pressure on my bones such as swimming or gentle stretches. Walking can be one of the best activities for bone health, but my joints limit how much I can do on my feet.
With all this in mind, I have to do what I can to support bone health while being realistic about the limitations caused by my RA. I work on getting calcium through my diet, along with taking a multivitamin. And I also exercise and walk a bit to strengthen my bones and muscles.
After that shock from my surgeon, the next time we met he apologized for what he said. He explained that he thought a lot of the bone damage likely came from the infection in my joint and that he should have made that more clear. I appreciated his clarification, but I also am glad to have had the warning that I should think about and care for my bone density as much as possible.
RA can be a strange disease—attacking the joints to cause damage while also creating fusion and calcification. It can be hard to tell if our bones are strong or not because they may move less yet be more delicate.
I think we need to remind our health providers to look at bone health along with our disease. Bone scans can be good indicators, but we also need to be mindful of diet and exercise for supporting the long term happiness of our bones.
For me it’s really easy to forget. I get lost in my daily aches, pains, and stiffness. I feel so hurt by my bones that I forget I need to take care of them! But I am reminded that I want my bones to be there for the long haul and so need to give them the care that will help them along the journey.
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