Practical advice for managing osteoporosis and work after starting Alendronate

[lostforbones]

Hello, looking for experience and real life knowledge. I was told I have osteoporosis in thoracic spine and osteopenia in hip yesterday (-2.9/-2.3 respectively). I am 56, post cancer, no HRT, generally fit. I have been prescribed Alendronate.
i have an active job which involves some overhead lifting (I’m a HCP but unfortunately not NHS as self employed). Just wondering what i need to do to manage this and whether my work will be affected? I’m aware of not wanting to either catastrophise (the rabbit hole of ChatGPT) or diminish and ignore, which I am capable of. Any practical, realistic suggestions?
thank you

And to add, I’ve seen a few threads discussing osteoporosis along the lines of ‘crippled with it’. Does this refer to fractures /pain/anxiety of falls?

"Crippled with it" means that you tend to break a rib when you cough or fracture a leg when you stand up. You're not at that sort of risk. As long as you are careful about how you lift, you should be okay. I've been taking Alendronic Acid (same thing as Alendronate) for years and do all sorts of exercise (obviously no high impact ones). As long as you are careful about how you lift, you should be okay. Was there a fracture that prompted your DEXA scan?

You might get more specific advice from the Royal Osteoporosis Society Helpline. Also, start doing their muscle building and bone strengthening exercises to protect yourself. Their videos are brilliant. Also, picking up On what a PP said, you are fully entitled to ask your GP if you can have an x-ray to determine if you have had any fractures

Thank you. That’s really reassuring and hopeful. I’m going to do everything I can to halt progression. I asked for the dexa because I’d lost 2” in height and DH noticed I was stooping. I’ve got chronic pain in my thoracic spine, so it fits I think .

That’s interesting. I did ask GP and she said she couldn’t refer for xray and I’d have to go to physio (which I’m happy with). I suspect I may have compression fractures in spine - see above (height loss, pain, curve) but will hold
off actively worrying until I’ve had X-ray. I’ll look at the ROS site - thanks for the tip

I have osteoporosis and took alendronic acid for three years, now on zolendronic acid infusions. I also have multiple other health conditions which cause me more issues day to day but I am always aware of the osteoporosis and I don't take risks as I may have done before.
Most people don't even know they have it until they break a bone. There aren't any symptoms as it creeps up . I think if you have an illness that feels better after you take a drug or other measures it's easier to view "progress".
I second the ROS. They have an excellent website with some very useful video tutorials. Their helpline is also good, I've used it a couple of times.

The obvious supplement is calcium / vit D though I'm aware the evidece of benefit is slim.You need 1200mg a day of calcium if you have OP and it's hard to reach that by diet.
Less well known is the need to up your proten intake, I was told this by the ROS.
Impact exercise and weights are useful.
I think you may need specific advice about your job.

I have osteoporosis, diagnosed 3 years ago following a wrist fracture. Had a Dexascan - no consult just told to take Alendronic acid, calcium and Vit D. After a bit of reading I decided I wouldn’t be taking alendronic acid and I wouldn’t be taking calcium - due to no evidence that supplements reduce fractures and increase risk of other problems. I’m 55 and I take Vitamin D in oil capsules and HRT - following a review of my bloods my oestrogen is still too low and that will need adjusting. My rheumatologist is happy with HRT and VIt D until something else happens. And of course exercise is essential - for every thing!

When I started alendronic acid I was told that it doesn't improve bone density but slows bone loss. So success is counted as no deterioration. After three years a further Dexa scan actually showed some improvement in my femur.

Everyone is alarmed when they read the risks of side effects from bisphosphonates. The ROS is very helpful in showing how to weigh up the risks of disease v the risks of side effects from bisphosphonates. My grandmother was indeed crippled by it and in horrific pain in her last years so I wanted to do as much as I could to mitigate.

My sister who is super fit recently had a triple leg fracture and a subsequent scan showed osteoporosis. I think it's important to be aware of it so you can try to avoid falls risks.

I would advise hrt if you are OK to take it post cancer? The estrogen in hrt slows down bone breakdown and preserves mineral density.

Their are other medications available if you are worried about alendronic acid - for example if you have problems with reflux - you are more likely to be given something else. I was told when I was ready to come off HRT there were better drugs available - be careful with calcium supplements - the best way to absorb it is through food - plain greek yoghurt - sesame seeds are good too. And don't eat loads of spinach - it won't make you stronger!
Ask your GP to test your hormone levels too.

unfortunately I can’t take HRT or I would definitely do this instead and then only take meds if hrt ineffective

Thank you. Really useful advice

DM has severe osteoporosis, with spinal fractures and deformed back, has six monthly injections. I have osteopeniaj(-2.1 iirc on dexa scan) discovered when I had a nasty fracture after a fall. I’m on Alendronic acid and adcal d3 and dietary advice. Not likely to do risky sports or activities in future but physical work should be ok.

I would be cautious. My femoral neck BMD is only just in the osteoporotic range (-2.5) however I have had two fragility-related fractures (pelvis and hip). Spine is osteopenic. I am on a bisphosphonate medication (Zoledronic acid infusions) and following a resistance based exercise plan. I also do a physical job and I am requesting an occupational health review and risk assessment when I return as my most recent fracture was exacerbated by an incident at work.

Another word of warning about calcium. As mentioned, there's no real evidence that high strength calcium supplementation decreases fracture risk in the general population outside of nursing homes, and excess calcium in the blood can cause significant health issues in itself. I only supplement a small amount in an H&B multivitamin and my last blood test showed my levels were on the very high side of normal and heading into slightly concerning territory. You really need to be monitored regularly if you're taking something like AdCal. My rheumatologist is more focused on Vit D and Vit K supplementation and also protein intake (1g per pound of ideal body weight), as others have said.

I have severe osteoporosis, partly due to early menopause and hereditary factors. Made significantly worse by years on prednisilone for autoimmune disease. So I have already had 3 fractures caused by minor events.
I have an annual zoledronate infusion.
My rheumatologist told me to stop calcium supplements and just take vitamin D.
I have RA which makes exercise difficult.
I was told that bedmaking/lifting the corner of the mattress is a huge risk for spinal fractures, so my DH always does that now.
I do isometric exercises and as much walking as I can manage.
I am careful to wear practical footwear and try not to lift heavy items. I now use a shopping trolley rather than carrying bags and it definitely protects my back.
I am retired now, so it is easier to protect my back.
I was taking calcium and vit K supplements, but as I had to stop calcium, I will look for a vit K supplement. This thread has reminded me!

It’s tricky isn’t it - there’s so much advice that isn’t based on good science. The calcium supplements my GP (who admitted to not knowing anything about osteoporosis) prescribed were a massive dose once a day and when I researched the type of calcium he prescribed it had very poor absorption levels. Never mind the other side effects and the poor track record on reducing fractures. The Vit D was the powdery kind that has poor absorption levels too and of course to help with Vit D3 absorption you need the right kind of Vit K which wasn’t mentioned either.
One thing I have worked on for fall prevent is balance - I do a single leg balance whilst I brush my teeth, 30 secs each leg then a 60 sec squat - I do heel raises too, I do single leg squats on the stairs while my coffee brews and I don’t use my hands or arms to get up from a chair or the floor I try to build strength through everyday activities - I walk and do other things too but the small things when done daily make a difference.

I gave osteoporosis and took ajemdronate acid, and then had the infusions. Not taking anything more now. Work never knew about the condition or the medicines I was taking.

Unless you need to make adjustments to your work pattern, then do they need to know?

it affected my travel insurance premiums more, especially as I’ve since had a fall and a fracture.

I was told to just take vitamin D as well!

@thepurplepenguin that's very interesting.
I have a massive family history of osteoporosis and I have taken a lot of steroids. I also have rheumatoid and osteo arthritis.
Vitamin K is hard on the stomach and I can't take it.
I have zolendronic acid infusion annually. I had three years on Alendronic acid before switching. I understand the bisphosphonates need calcium to fuse to. I've taken adcal for years but would like to manage calcium in my diet. It's not easy, especially if you don't eat cheese. I thought I had an answer as I read that dried skimmed milk is high in calcium and can just be added to coffee and sauces. Unfortunately I didn't reckon with the taste - super sweet and sickly.

Thank you - that’s so helpful, both the exercise and nutritional advice. I vaguely recall something about vit k aiding h absorption but need to read up on all the advice as embarrassingly o never considered osteoporosis as a possibility.

I think I have to tell work as in terms of professional indemnity and code of ethics (HCPC requirements).

I make a lot of beds (at home, not work).