Spinal BMD in Patients with Scoliosis

The purposes of a retrospective study published in the journal, “Spine” were to investigate the validity of bone mineral density measurements with DEXA in patients with adult lumbar scoliosis and to investigate the association between osteoporosis and adult lumbar scoliosis. Osteoporosis and lumbar degenerative scoliosis are phenomena encountered with increased frequency in aging, often concurrently. Scoliotic patients demonstrated increased spinal bone mineral density (BMD) measurements compared with nonscoliotic patients, resulting in discrepancies between hip and spine BMD values. This discrepancy correlated with aging and curve magnitude (up to 30% for curves of 43°). Scoliotic patients demonstrated significantly lower hip BMD values than nonscoliotic. Curve magnitude did not correlate with severity of osteoporosis.

Spinal BMD values are less valuable for monitoring osteoporosis than hip values in scoliotic patients; an increasing discrepancy with age was noted. Scoliotic patients exhibited discordantly high spinal BMD values, despite significant hip osteoporosis. The discrepancy correlated with aging and curve magnitude. Scoliosis was common among the osteoporotic population (9.47%). Lumbar scoliosis is a useful clinical marker for osteoporosis, irrespective of scoliosis history and magnitude. Viable alternatives for osteoporosis evaluation of adult patients with lumbar scoliosis are hip DEXA values, in conjunction with other BMD measurements.

http://journals.lww.com/spinejournal/Abstract/2006/06150/Discordantly_High_Spinal_Bone_Mineral_Density.19.aspx

When to Stop Taking Strontium

When to stop taking strontium after having taken it successfully for a number of years is a good question. Once you reach normal bone mineral density (BMD), it makes sense to stop taking strontium and just monitor your BMD. If your BMD readings are at the osteopenia stage, defined as a T-score between -1.0 and -2.5, the decision becomes more complicated. As I see it, the choice, at that point, is either to reduce the dosage or continue with the full dose until normal BMD is reached. I would definitely not stop taking it altogether after reaching a BMD in the osteopenia range.

I have been taking 680 mg strontium from strontium citrate for osteoporosis for six and a half years. My lowest T-scores have always been at the spine. Last year (2013), my T-score at the spine from L1-L4 was -1.6, which is in the range of osteopenia. I have continued taking the same dosage since then. I may wait another year until my next DXA before deciding on any change.

One person I know from an osteoporosis forum says she had osteoporosis and achieved normal BMD after 4.5 years on strontium citrate (lucky lady!). She says she took 680 mg strontium for 3.5 years and then 340 mg for the final year. She then stopped taking strontium but had yearly DXA scans. Two years later, her BMD is still at the normal range. Don’t be discouraged if your results aren’t quite as spectacular; mine aren’t compared to hers. What is really encouraging to me is that she has retained most of her gains in BMD after two years!

http://www.inspire.com/groups/national-osteoporosis-foundation/discussion/strontium-citrate-25/?ref=as&asat=172752721 (Charella’s update after two years off strontium is nestled within a discussion started by another forum member.)

http://www.inspire.com/groups/national-osteoporosis-foundation/discussion/success-with-strontium-continues-to-be-great/ (Charella’s update after more than one year off strontium citrate is featured in a discussion she initiated.)

Secondary Causes of Osteoporosis

Secondary causes of bone loss are not often considered in patients who are diagnosed as having osteoporosis. In some studies, 20% to 30% of postmenopausal women and more than 50% of men with osteoporosis have a secondary cause. Before starting a course of treatment for osteoporosis, whether with over-the-counter strontium citrate or with a prescription drug, secondary causes of bone loss should be ruled out. In secondary osteoporosis, treatment should include treating the underlying cause of the disease. This short article by the International Osteoporosis Foundation (IOF) lists most of the causes of secondary osteoporosis. The causes are broken down into four categories: medical conditions, hormonal, other links, and medications or chemicals.

http://www.iofbonehealth.org/secondary-osteoporosis