THR Anyone have low bone density/ osteoporosis?

[Puggles]

Hello bonesmart peeps!

TL/DR:

Thanks to someone here who posted about a cracked femur after
THR, I realized I needed to learn some new info and ask my surgeon about it.
If you had/ have low bone density/ osteopenia/ osteoporosis, did you and your
surgeon know about it BEFORE your THR? If so, were you prescribed medication/ change
in diet / vitamins D and calcium before they felt safe operating on you? Did taking
these things actually help your bone density in a significant way? How long did
you have to take these additional things to get your bones stronger?

OR, did they know about your
bone problems, but still felt it was safe for you to have the THR(s)?


-------------------------------------------------------------------------


The long version:


Someone posted here about their experience with either having their femur actually
crack after THR *or* they may have only said that their surgeon was concerned about it.
Either way, it made me realize that I needed to remember to ask my surgeon
about the risk. 21 years ago, (I was 36), I had several large fibroids on my uterus and opted
to have them removed. My surgeon said they needed to shrink signifcantly
to safely remove them, so he started me on monthly
injections of a med called Lupron Depot, which causes pseudo menopause (by the
way, it was NOT fun feeling menopausal at such a young age ...eeek!)

I got these injections for about 8 months to a year. I didn't realize until recently
that all that lack of estrogen MIGHT have weakened my bones. Last week
I asked my (possible) hip surgeon about it, and he definitely wants me to have
bone density testing.

Thanks again to this awesome site! I would never have known to mention
this to my surgeon! I'm now scheduled for bone density testing, and I'm so
curious what the results will be.

On a related note, because this test requires lying flat, I already know it's going to
be VERY painful (if not impossible) for me. I'm even more afraid that I
literally will NOT be able to lie flat as long as required, and they'll have to cancel
the test halfway through or something. I need to psyche myself up for this,
because if my surgeon can't find out this info, he probably won't risk
the surgery. Ugh!

I read that there are manual machines that don't require lying down (yippeee!),
but I have a bad feeling mine will be the kind that requires it. I wonder if
my surgeon could dictate which type of test I have?

 

[Mojo333]

Hi @Puggles
Hope some members that have dealt with this can come by with firsthand knowledge.

I'm glad your surgeon is aware and you are scheduled for the test.
I don't know if you can emphasise that you can't lay flat for very long so they can use that alternative method.
My bad hips diagnosis was only after a lot of tests for back issues, and I had a bone scan that lasted an incredibly LONG ten minutes because lying flat was so painful.

I do know that directions will be given not to take calcium supplements in the 24 hours prior to the test.
Our Nurse Emeritus, now retired, mentioned to a member (as she was a surgical nurse for prominent hip surgeons) that, in cases of osteoporosis, the Surgeon will choose to cement the hip.

 

[Cementless]

@Puggles: I have osteoporosis of the L hip as verified by my recent Bone Density test 08/05/2021. Osteopenia of my L femur too. Osteoporosis in my back. At this time, I do not need a hip replacement. I had a L knee revision done on Oct. 3 2018. I fell a month ago on my left revised knee, leg, hip. The x-rays did not show any fractures and the revision was stable. My left knee and left hip still hurts. I am wondering if I might have a stress fracture of my left hip that did not show up on x-ray. I am in the process of contacting my OS to see if I need an MRI to see if I have a stress fracture.

It was uncomfortable to lay still for 10-15 mins for the bone density test but tolerable.

I too would like to know what others are doing, medication wise for their osteoporosis. I take A LOT of Vit D3 and Calcium. Cannot tolerate Fosamax. Very sedentary. My leg bones feel weak. I will be 74 next month. Trying to do more exercising but hard when your hip and knee hurts.

 

[Elf1]

@Puggles I have some osteopenia in the spine, don't remember seeing anything on the reports about my hips though. I'm not even sure they included them.

I don't remember the test(s) taking very long, I've had multiples. I have spine issues so laying flat on a hard surface isn't fun but is bearable to get the test done. I would recommend you let them know that it's painful to lay flat on your back before they start the test so they're aware.

Because it is osteopenia and not full blown osteoporosis I would imagine is why my neurosurgeon wasn't very concerned with it prior to my spine surgery. Don't know how helpful that is but figured I'd share my two cents.

 

[Nyc1961]

Hello,
I also have osteopenia and when I mentioned it to my surgeon before my anterior hip replacement, all he said was that he would determine what needed to be done once he started operating. Now after 11 months and constant pain and problems, I still can’t believe my ignorance in not asking specific important questions before undergoing such a major procedure; what was I thinking! Totally trusting that whatever he decided to do would lead to a positive surgical experience with no problems. Total ignorance on my part! My femoral stem was cemented and he noticed a slight crack at the neck of the femur. He
made the decision to use a cerclage cable as a precautionary measure and also inserted two iliac screws because of poor bone quality. So 11 months later, have severe trochanter bursitis and psoas impingement and was told there is still no ingrowth in the hip cup. At this moment, I am sorry I had this surgery. I am dealing with so much stress and multiple problems.

 

[Puggles]

@Nyc1961 ---Ugh, I am SO sorry for all you've been through!


@Cementless---I'm sorry you had a fall and are in pain. I hope your MRI leads
to answers, and.....NO MORE pain!


@Elf1 ---Thank you, every piece of info is VERY helpful ! It's also educational
to learn ALLL the other things people have been through besides a THR. I'm sure
you'd agree, in SOME cases, all of these things can be related. For example, when
my hip pain first started, a lot of the reading I did said it COULD BE spinal. Ugh, and
don't get me started on how my sudden knee and heel pain is probbbably
related to how horrible my gait is, etc. etc.



@Mojo333 ---Wowwww, the new things I learn here!! Sooo, now I'm gonna make hubby laugh and ask him if HE can do it for me. He still has cement left over from when he built an outdoor storage house
I mean....the way this delta variant is causing hospitals to be completely FULL, not to mention, nurses quitting (I don't blame them, poor things), I am freaked out by the thought of being anywhere NEAR a hospital !!!

**I think it's time for me to go read some POSITIVE recovery stories!!!

 

[Puggles]

Thank you to everyone who replied!

I'm scheduled for the Bone Density scan Sept. 9th.

Hubbs didn't realize it until yesterday, when we were discussing it
again----he asked me WHY the surgeon hadn't asked me about
my bone density before? He's upset that the surgeon hadn't
planned to check BEFORE scheduling the THR. He was
incredulous that the ONLY reason I'm getting the bone density test
was because I mentioned my past medical reasons for it.

Hubbs
thinks the surgeon should have ASKED me if I had any reasons
to be concerned about my bone density. I told him again
that THANKS TO THIS SITE ---I learned that a femur
fracture during surgery was possible. Had I not read those
posts, I never would have known that I was possibly at
high risk due to Lepron-Depot injections they gave me 20 years ago..... SO---THANK YOU ALL AGAIN!!!

I certainly don't know the answers, and I'm NOT a surgeon.
The googling I've done says that MOST doctors don't test for
bone density until age 65. That makes me think I should NOT
be upset that my surgeon hadn't thought of it.


After reading Nyc1961's very painfut story, it does make me question
things even more. If some surgeons (like hers) would
rather wait until the middle of the surgery to find any problems, is
that really a good thing? Maybe I'm wrong, but if a patient
TOLD ME about a potential problem, I'd rather
know the obstacles BEFORE opening the patient up for a major
surgery!

Then again, maybe all the bone scans, MRIs, CTs,
etc. aren't as accurate until the surgeon actually visualizes
our problems in person! Ugh, I analyze things wayyy too much!
I sometimes wish I was in denial, assumed everrryyyything
was sunshine and puppies like some people do.

 

[Puggles]

Welll......tomorrow is the bone density test! I'm already pre-worried about
how far we'll have to walk, even though I'm taking my
new, awesome walker.

Also worried about whether I'll be able to
even get through the test, since lying down and / or
changing positions is excrutiating!


One GREAT thing is that it's on the first floor of the building.
I would NOT want to get on an elevator now with the Delta
surge---especially since so many in my state aren't vaccinated,
AND sooo many refuse to wear masks

I'd put this off longer if I could, but Covid isn't going anywhere,
PLUS, I'm getting my much-overdue mammogram immediately
afterwards.

 

[Puggles]

I hope someone here can help me understaaaand !!!!

I have read (and re-read five times, AND googled a LOT !!!!) about
what my scores mean, and I am LOST.
My doctor's office called late (on a FRIDAY, of course) so I
haven't gotten to talk to them yet. The radiologist who
read this said "treatment needed."


Study Result
Impression
1. The lowest measured bone mineral density is considered osteopenic according
to World Health Organization criteria. Bone density is between 10 and 25%
below young normal.
Fracture risk is moderate. Treatment is advised.
(*** I do understand this result, obviously!)
2. The FRAX 10 year probability of fracture is calculated as 7.1% for major
osteoporotic fracture and 0.7% for hip fracture.
(****I do understand this very clear result!)


**THIS part confuses me, because all my (except for my lumbar spine) scores apply to
each of these !!!)
Normal: T score at or above -1.0 standard deviations.
Low bone mass/osteopenia: T score between -1.0 and -2.5 standard deviations.
Osteoporosis: T score at or below -2.5 standard deviations.



Narrative
Exam: DEXA bone density study; 9/9/2021 4:25 PM CDT

The bone mineral density for the lumbar spine (L1-L4 ) is 1.223 g/cm2, which
corresponds to a measured T score of 0.2.
(THIS is the only result I understand.....and it's kinda scary!)

The bone mineral density for the left femur neck is 0.796 g/cm2, which
corresponds to a measured T score of -1.7

****According to the chart,
1. -1.7 is normal (at or above -1.0 ) and.....
2. -1.7 is also low bone mass/ osteopenia, ( -1 to -2.5) and....
3. -1.7 is also osteoporosis (at or below -2.5)
! ? ! ? ) ***


The bone mineral density for the right femur neck is 0.783 g/cm2, which
corresponds to a measured T score of -1.8

1. -1.7 is normal (at or above -1.0 ) and.....
2. -1.7 is also low bone mass/ osteopenia, ( -1 to -2.5) and....
3. -1.7 is also osteoporosis (at or below -2.5)
! ? ! ? )



The bone mineral density for the total left hip is 0.809 g/cm2, which
corresponds to a measured T score of -1.6.

1. -1.7 is normal (at or above -1.0 ) and.....
2. -1.7 is also low bone mass/ osteopenia, ( -1 to -2.5) and....
3. -1.7 is also osteoporosis (at or below -2.5)
! ? ! ? )


The bone mineral density for the total right hip is 0.703 g/cm2, which
corresponds to a measured T score of -2.4

1. -1.7 is normal (at or above -1.0 ) and.....
2. -1.7 is also low bone mass/ osteopenia, ( -1 to -2.5) and....
3. -1.7 is also osteoporosis (at or below -2.5)
! ? ! ? )

-------------------------------------
Here's a photo of my RIGHT from the scan....
(P.S....both hips need replacing---yipppeeee!!! )

 

[BBCG]

Hi Puggles, it has been a while since I've read my scores, and I'd have to go figure out how to look them up, but I was diagnosed with osteopenia a few years ago. To rebuild and strengthen my bones, I have focused on walking regularly, I have taken (and will eventually resume once Covid makes it safe again) Better Bones exercise classes, and I take AlgaeCal, a non-rock/mineral calcium supplement made from a sea vegetable.

Because I am my husband's caregiver following his battle with leukemia, I haven't had a re-done reading in the past few years, but should get one again to see where I am. I would urge you to do LOTS of research before you take Fosamax or any of those drugs, because there are pretty significant side effects for some people. My research led me to avoid them completely and go for other ways to keep my bones strong. But, each person should research every trusted resource they can before making these critical decisions. My doctor knows of my point of view and is supportive of me doing everything I can to avoid taking these drugs.

Your situation seems to beg for some quick research on your part to see how quickly you can find some answers to what to do... I got on this topic early because my mother had osteoporosis and had some major complications from it, so I didn't wait to study up and get on top of it!

If you want more information, let me know, but I researched "bone strengthening options" I think, early on, which led me to some physicians heading up various organizations that help people find drug alternatives when they choose to look for them...

Oh, and my TKR doc said nothing about osteoporosis or bone density, either!

 

[Puggles]

@BBCG ----Thank you so very much! Such great information!
I have done SO. MUCH. googling, but I just cannot figure it out!


As I mentioned in my OP---ALL my scores fall within the ranges
of "normal, OR osteopenia, OR osteoporosis"

For example---let's say we have labwork done. We see our fasting glucose is 90. We know this
is GOOD, because in the next column, the lab has told us
the normal range is 80-100.

But with my results, the number range is the same for each
category.

It's as if the range said: "a glucose of 90 is too low, OR it's good, OR it's too high." Pick one, and good luck!

 

[BBCG]

I think the ranges you were given are somehow not pulling correctly from whatever source they are from. It's probably a silly computer software error, too!

I bet the software should be corrected and you should contact the place it was done to complain and ask for clarification. What you were given is not explicable or logical! Do contact the place you had it done, and tell then what it says, and ask for your records to be sent again but correctly delineated...

Has your doctor seen these results? If so, they might have faster response time, perhaps?

Actually, if you look at the first part of your scores, the guidelines are correct there:

Normal: T score at or above -1.0 standard deviations.
Low bone mass/osteopenia: T score between -1.0 and -2.5 standard deviations.
Osteoporosis: T score at or below -2.5 standard deviations.

So, if that's true, then your scores are as follows (but YOU should not have to be figuring this out!):

The bone mineral density for the lumbar spine (L1-L4 ) is 1.223 g/cm2, which
corresponds to a measured T score of 0.2.
(THIS is the only result I understand.....and it's kinda scary!)

BUT: this could mean that since your score is ABOVE -1.0, you're good!

The bone mineral density for the left femur neck is 0.796 g/cm2, which
corresponds to a measured T score of -1.7

This could mean your score of -1.7 is osteopenia, not osteoporosis yet! This is treatable with the algaecal calcium, weight bearing exercise, etc.

Then:
The bone mineral density for the right femur neck is 0.783 g/cm2, which
corresponds to a measured T score of -1.8

Again, -1.8 is osteopenia, not yet osteoporosis!

And so forth, down the list... See what I mean? If you sort of ignore their confusing and erroneous efforts to tell you where your score falls, and just look at the numbers they're claiming say which degree is which, you might not be in too bad of shape...IF you actively take measures to improve the density of your bones.

The organization I found helpful is called SaveOurBones and they are online. They have done research on the side effects of some of the drugs, so I found that a cautionary tale and so took measures to get regular exercise, decrease inflammatory foods, etc. My female relatives all had osteoporosis, but their lifestyles were quite different from mine, and I've taken every measure I can to avoid needing the drugs! But, that's me and you can find and choose your own path, of course!

 

[Mixii]

Oh, @Puggles, I feel every bit of this.
When I was 47 I had a dream that my bones turned to glass (like quartz crystal). I thought "well, that's weird" and, heading towards menopause, decided to get a baseline DEXA bone scan so that I'd have a reference going forward.
Report: osteoporosis of the spine, osteopenia of the left hip. At 47?! Repeated the test the following year on the same machine: same report, but a bit "worse." I've not had another scan because I don't intend to take the drugs available and I don't want to stress myself out. I take calcium, Vit. D3, Vit. B12, and try to stay active.

When I mentioned considering hip replacement to a friend, he went into a whole spiel of "don't do it" and a story about his neighbor who had her hip replaced and her bone fractured, and...I lost it. Up until that point it had never occurred to me that my bone could fracture during surgery. (For the record: the neighbor was 95 and sedentary.)

I did a ton of reading. I asked my surgeon a lot of questions.
His response: he assumes fragile bones in patients who are menopausal or post-menopausal. He didn't recommend a bone scan because the X-ray gives him the information he needs. (And a "bad" scan would have stressed me out entirely.)

I did a lot more reading about the implants he was intending to use and my specific conditions (OA, acetabular protrusio, osteopenia). Not "WebMD," but articles and research published in recent orthopedic journals. And I asked more questions.
The entire concept scared the bejeezus out of me. It still does.
The only things I could and can control about this are my choice of surgeon, my decision to proceed, and my physical and mental health.

I had a direct anterior approach left THR on 25 August. Press-fit acetabular cup (bone graft behind) with 1 screw, cemented femoral stem. My surgery was at 7:30am; I was home by 1pm the following day. This Wednesday marks 3 weeks post-op for me; I'm cautiously optimistic.

My advice, for what it's worth: make the best decision you can with the information available to you at the time, then let it go. Breathe, meditate, walk, drink tea — whatever it is that calms you. You can make yourself crazy by overthinking.
And the advice from my surgeon in response to one of my fretful emails: "Get confident and let someone help you."

Sending you all the good vibes.

 

[Puggles]

@BBCG
@Mixii

WOW! THANK YOU BOTH soooo much !!!
Finallllly, some good info !!!
BBCG--you explained it so well----ugh, I knew something
was weird.

I have lots of reading to do !!!!!

 

[Puggles]

My bad hips diagnosis was only after a lot of tests for back issues, and I had a bone scan that lasted an incredibly LONG ten minutes because lying flat was so painful


Ohhhh yes.....wasn't it just excruciating?!?! Ugh, I tried...oh, how I tried,
but the tears started coming, it was sooo painful. ---The tech had
NO EMPATHY, by the way!---But I took deeeeep breaths and started
thinking about my sweet doggies' faces, and it really helped!

I was so surprized that the tech didn't even offer me some tissues! I could tell she'd had a lonnnng day, and was probably hating me and couldn't wait until I was gone.

 

[Mixii]

Congratulations, @Puggles — you did it and now can continue your journey.
Really try to work through some of your anxiety as you continue; stress and anxiety exacerbate pain.
A (((virtual))) hug to you and to your poor tech who has how many patients daily that they cause more pain to simply by doing their job.

 

[Puggles]

@Mixii ---thank you, and yes, I do need to lower my anxiety! I
realllly didn't think I'd cry, but it hurt SO badly to lie flat for so long.

A (((virtual))) hug to you and to your poor tech who has how many patients daily that they cause more pain to simply by doing their job

Exactly! I have SO much empathy for ALL healthcare staff! I always assume they are tired and stressed, and I get it! My ONLY wish was that she'd
at LEAST handed me some tissue. I was crying so much, my masks
were soaked.

 

[Mixii]

"My ONLY wish was that she'd
at LEAST handed me some tissue. I was crying so much, my masks
were soaked."

That's reasonable. I so hate a wet mask, nor is a wet mask effective.
But...you're through it! Take a couple deeps breaths before your next step.

 

[Puggles]

@BBCG and
@Mixii

I wanted to thank you both *again* for allll of the wonderful
info and support! I just re-read both of your replies, and it
was so helpful! I saw my NP yesterday, and--ugh---
they were running *very* late, which made my appt. go half
hour past their usual closing time, so it was an unfortunate rushed appointment.

I can't remember the name of the drugs from yesterday,
and haven't had time to research (yet) because my day has
been too busy.


She wants me to get a medication that not only prevents
further bone loss, but can even re-build. I have to decide whether to get monthly injections
at the office, OR, I can self-inject once per day.

She ordered a bunch of labwork to give her more info,
and decide which treatment I'd prefer.

What bothers me is that this info was told to me so quickly,
with no option to ask questions, and it reallllly bothers me
that she didn't even consider that maybe I'd like to deal
with this with no injections. She would prefer that I
get injections 3-6 months before attempting the THR.

Interesting tidbit she threw in, and I'd love to hear from
anyone who knows is regarding the cost. She said
the clinic injections will most likely be covered by my
insurance, but the self-injections are usually not
covered, and quite expensive. I obviously have A LOT
of research to do, but today has been too busy with
other things, so I haven't even started.

After way too many rushed appointments and/or personnel
who are exhausted, I am getting to the point where I don't
want to step foot in another doctor's office/ clinic/ lab !


As I said before, I have a *lot* of empathy for medical
professionals (even way before Covid!), so I am
trying to be very patient and not complain. However,
I've experienced several rude/ rushed/ uncaring personnel before,
and I am just so sick. of. it .

If you are still reading my "novel", I'd also like to add that
when I had a hip MRI about 5-7 years ago, the tech was
so rude, so rushed, kept sighing, slamming things, etc. It
was *so* uncomfortable for me, yet, I still tried to make
jokes, also told her I was sorry she'd obviously had a very
hard day, etc. Didn't change a thing.

I'm mentioning this because I am considering seeing
a new surgeon, and unlike the others in the past, this
one won't even see me until I have an MRI. Wow! No
surgeon has ever required this before. I can totally
understand why, though----he is probably trying
to eliminate wasting his time, etc. What I hate is
that I'm already dreading if this next MRI tech is
going to be rude like the others.

I'm just *so* sick
of being treated like this, it's just another reason I
have avoided surgery for so long. I cannot
take one more tech slamming things, sighing, treating
me like dirt, etc.

 

[subie2021]

Hi Puggles,
Sorry that you are struggling with so many decisions.
What has helped me is to step back and take a different perspective. I think it's normal, when we are anxious and not doing well physically, to want and need to be cared for. But not everyone we encounter meets that need.
At my first meeting eith the surgeon he burst into the room, went on a sort of spiel about the causes of hip pain and the possible downsides to surgery. It was off-putting to me and wasn't exactly fitting my needs for some shoulder patting - if you know what I mean. I walked out with a surgery date but gave some thought about maybe seeing someone else.

But then I remembered that this guy is The Hip Guy in my area and has a good reputation as a surgeon. Online reviews mentioned his brusqueness so I know his attitude wasn't directed at me in a personal way. And I knew I needed a good competent surgeon, not a new BFF. I had other people to lean on for emotional support. So I stuck with him, had the surgery, found him to be much more supportive if we talked about more technical/surgical questions
and I'm very happy that I did. I couldn't be more pleased with his work.

If it helps, I can tell you that my surgeon wanted imaging before our initial appointment. I think it saved us both some time, because with it he knew what was going on with my hips, and without it it would have just been an appointment to tell me he needed imaging.

As for your angry MRI tech, perhaps remember that your job is to go in there and get the imaging done, and theirs is to do the imaging. What does it matter in the long run what their attitude is as long as the job is done? You be your nice self and let them have their bad day. I think of George's father on Seinfeld...in awkward situations how he yells "Serenity now!!" and it helps lighten up my attitude.
Does your health care system send out post-visit surveys? That's a good place to complain about poor service. And there is always the option of writing or emailing the department head or even the CEO. I've worked in healthcare for a long time and I know that they pay attention to feedback.

Also know, even it they don't explain the reasons to you, that for some imaging the positioning will be uncomfortable or even painful. You can ask if there is anything they can do to help, but sometimes the answer is there isn't. You can speak to your own doctor and let them know that certain positions are painful, and they can prescribe meds to help out on imaging day.

Best wishes going forward. Serenity now!