Osteoporosis, warfarin & vitamin K

[catwoman]

Had a bone density test (my first) last Friday and another mammogram. Mammogram was fine, but my PCP's nurse called to say I had severe osteoporosis and have to begin ASAP on maximum dosage of Fosamax.

Understandably, I'm down.

I've had back problems for the past several years, usually just when I would be bathing a cat in the kitchen sink. Started having more problems when I was master clerk at cat shows (certifiying paperwork from all the judges and making a master file of everything on every cat in the show) around December. I mentioned my back to my PCP during my physical 2 months ago & he ordered a bone density test. I reminded him that in March 2003 he had suggested doing one until he realized my valve was deteriorating and all focus shifted to my heart.

The RN said I have to also take 1,500mg of calcium daily + vitamin D. Didn't mention walking/weight-bearing exercises, but I know I will have to do that every day.

On Feb. 15, 2005, Al posted a summary of a study by C. Barnes et al about 17 kids who had been on warfarin at least 8 years, showing they had lost bone density compared to a control group. So now I'm wondering how

My PCP gave me a scrip for Flexeril (generic), but it hasn't helped the pain. I've been having problems sleeping for about 6-8 weeks. Even taking Extra Strength Tylenol PM doesn't keep me asleep the entire night now.

Any suggestions from anyone on pain relievers for this type of pain? Sometimes it's enough to set up muscle spams in the upper half of my back; sometimes it's only along the upper spine.

Is there a medical specialty that treats osteoporosis (other than orthopedists)? I can self-refer if needed.

I don't want to take things that will throw my INR into a tail spin, but I also know I need to get on top of this right now.

Thanks for listening to my rambling -- and to any suggestions.

 

[Blanche]

Catwoman:
Al has severe osteoporosis. He takes Fosamax weekly and 1,500, mg calcium daily. I fear that people who are on Coumadin/Warfarin, which is a vitamin K antagonist, are quite likely to develop osteoporosis because Vitamin K is necessary for bone health. But, the, I don't take anticoagulants and I have Osteopenia, which is the step before osteoporosis. And, I took 500mg calcium all my life. Now, I take the same meds as Al. We have had bone density scans for the last four years and we both have improved a little each year. Neither Fosamax nor calcium should effect your INR.

I would encourage everyone, especially those who are on anticoagulants, or those who are slim to take calcium daily. I hope the articles that I have included here will be of some help to you.
http://www.acu-cell.com/dis-ost.html
http://www.ctds.info/vitamink.html

Blanche

 

[Nancy]

Marsha-

I have a stress fracture in my lower spine. It's my old football injury I was a cheerleader and over-rotated my back and it broke, although not severely. All of my adult life, from time to time, I have had periods of pain, some severe, and some just in the morning when I wake up.

Several years ago, I did go to physical therapy and was given a whole series of back exercises made up especially for my own condition and taught me how to move safely. The exercises really help with the pain, which like yours can be mainly muscle spasms. I can sometimes feel bone on bone grinding, but the muscle spasms are what causes the most pain. When you have strong muscles in your back it protects it.

Now I am on Arimidex after breast cancer surgery and that causes bone loss. I have osteopenia anyway. I do take calcium and Vit. D, and now am on Fosamax too.

Why not ask about PT for your back?

 

[Christina]

Osteoporosis Revisited.

Osteoporosis Revisited.

I just need to put in my 2 cents. I also have Osteoporosis in my spine and my previous doctor had been hounding me to take the drug "Actonel" (sister drug of Fosamax) last year. I finally gave in to get him off my back. I took it two times (once a week). The side effects were so severe that I ended up in the ER with charley horses in my chest. The chest pains were so bad that I thought I was having a heart attack. They right away tested me and said that it wasn't a heart attack, but where was that chest pain coming from? The last doctor we saw when the shift changed couldn't say it out loud that the pain I was having was caused by side effects of this drug, but she showed us her little pocket computer and let us read what it said. The pains decreased over time but lasted a full two weeks.
The only thing that'll increase bone density is vitamin K, and of course we Coumadin consumers have to be careful with that. At this point I don't know what to do. I also have low back pain at times and have been having this for several years. I started drinking goats milk just recently hoping that that will increase my bone density. I have been taking calcium and glucosamine for years but somehow it isn't being obsorbed. I take them three times a day and am very good about it.

For the people that think "Fosamax" is the answer... Please click on the following link.

http://www.vitaminlady.com/articles/osteoporosis2.asp

Hope this all helps.

 

[catwoman]

I took 70mg Fosamax this morning. We'll see what reaction, if any, I have.

A friend called from Alexandria LA last night to check on me. Warren turned 50 in February, is extremely thin (eats like a horse, though!) and was a very heavy smoker for years until quitting cold turkey about 12 months ago. He has osteoporosis, has been taking Fosamax & calcium tabs. Says he had stress fractures in the spine, that the Fosamax has been helping a lot. He's a veterinarian ("small" animal practice), so he has to hoist big dogs around at work.
He said as long as he doesn't do a lot of bending over, he's OK. He takes ibuprofen for pain. I'm not going to mix warfarin w/ Fosamax, calcium AND ibuprofen, so I'll probably try Alleve if the extra strength Tylenol doesn't help.

I'm hoping I can turn this condition around... went walking for 30-40 minutes last night and it was painful. Need to walk -- a good weight-bearing exercise -- but if you're in pain, it works against you.

 

[Guest]

There is a limit to the amount of calcium that the body can absorb and utilize. It seems to me that the recommendation is that if you are taking 1500 mg/day it should be 750 mg twice a day for the best utilization.

 

[Marty]

osteoporosis specialist ?

osteoporosis specialist ?

At our clinic ,internists with subspecialty certification in rheumatology are referred the most difficult cases of osteoporosis. I'd advise consulting one of these doctors in your area. You need to find the cause of your back pain before it can be treated properly. There has been alot of progress in this field in the last few years.

 

[catwoman]

There is a limit to the amount of calcium that the body can absorb and utilize. It seems to me that the recommendation is that if you are taking 1500 mg/day it should be 750 mg twice a day for the best utilization.

Instead of 500mgX3???

 

[catwoman]

At our clinic ,internists with subspecialty certification in rheumatology are referred the most difficult cases of osteoporosis. I'd advise consulting one of these doctors in your area. You need to find the cause of your back pain before it can be treated properly. There has been alot of progress in this field in the last few years.

Marty:
Thanks! I think I'll ask my PCP for a referral to a specialist. See if he can refer me to a rheumatologist. My youngest sister (has RA, lupus) has a rheumatologist in Dallas and perhaps he/she knows someone here in Fort Worth (about 30-50 miles apart).

 

[Guest]

I didn't mean that 750 mg twice a day was the only possible dose. 1500 mg once per day cannot be properly absorbed and utilized. 500 mg X 3 is also OK but most people do better trying to remember something only twice a day rather than 3 times daily. Almost no new drugs are being developed that need to be taken three times daily because people do not take them regularly.

 

[Blanche]

Calcium absorption is a real problem and there are many factors involved. For example, it is necessary to have acid in the stomach for calcium to be broken down for absorption. I smile when someone says they take Tums for the calcium. My doctor said that 500 to 600 was the most calcium that should be taken at one time. He suggested the three times a day routine, and I was an absolute failure at first. Breakfast was fine and dinner was too, but I almost always skipped the one at lunch. Now, I have gotten into the habit of having some orange juice between lunch and dinner with a tablespoon of liquid calcium. That seems to work for me.

Al and I have been taking Fosamax for nearly five years, with no side effects. But, I do know a woman who did have problems similar to the ones that Christina shared. Al and I have shown improvement over the last four years, a few percentage points a year, but it is highly unlikely, if not impossible to reverse the problem completely...especially if one is on Coumadin. My results have been better than Al's results. Perhaps this is because I take Vitamin K daily.

Finally, it was explained to me that the benefit of Fosamax was that it helped in maintaining bone health by stopping the loss and calcium is what helps reverse the loss.

Blanche

 

[catwoman]

Al:

Thanks for the explanation. Because I eat 3 meals a day, it's easy to remember to take it then -- if less than 8 hours apart is OK.

 

[Marge]

I fear that people who are on Coumadin/Warfarin, which is a vitamin K antagonist, are quite likely to develop osteoporosis because Vitamin K is necessary for bone health.

I don't understand why that would be true unless the person stopped ingesting sufficient amounts of Vitamin K -- which I was told was not necessary to do. [ I only had three months on warfarin after my valve repair surgery -- now, a year later, have had to start on it again for atrial flutter. ]

I eat a lot of green vegetables. I also take calcium. I was told by the anti coagulation clinic that is managing my warfarin to continue with my regular diet, including the greens, and to continue taking calcium (as long as I don't take it within two hours of taking warfarin). They said they would work my warfarin dosage around my diet and lifestyle, including the calcium.

Assuming I was ingesting plenty of Vitamin K & or calcium, if I continue to ingest just as much vitamin K as ever, and take the same amount of calcium -- how could warfarin put me in danger of osteoporosis?

 

[Guest]

Understandably, I'm down.

Yep, I understand what you mean. I hope that today finds you a bit less down than you were....

I don't have any advice/answers for you; just wanted to let you know thoughts/prayers are coming your way.


Cort, "Mr MC" / "Mr Road Trip", 31swm/pig valve/pacemaker
'72,6,9/'81,7.hobbies.chdQB = http://www.chevyasylum.com/cort/
MC Guide = http://www.chevyasylum.com/mcspotter/main.html
"We got mountains to climb" ... Rod Stewart ... 'Broken Arrow'

 

[Blanche]

Marge:
You are correct. While taking Coumadin, you can have all of the greens you like and ingest all of the vitamin K that you wish, as long as you are consistent. There is no need to change your diet. And, Coumadin does not affect the calcium intake. But, and this is the rub...Coumadin is a Vitamin K antagonist. In effect, Coumadin neutralizes the Vitamin K that you ingest and the vitamin K that your body makes in the intestines. As a result, by definition those who take anticoagulants will always be deficient in Vitamin K because this Vitamin is "blocked" by anticoagulants.

If you take large doses of Vitamin K or ingest foods with high levels of Vitamin K, your INR will decrease and then your Coumadin dose will need to increase. We know that Vitamin K is needed for bone health, so if you are stopping the Vitamin K with anticoagulants, you will likely have problems that are likely to result in bone loss...

I know that my explanation leaves something to desire. I'll see if I can find an article on this for you. I hope that Al Lodwick will help explain this better.

Regards,
Blanche

 

[Guest]

Blanche explained it pretty well. The only part missing is that there are no studies proving what effect a high intake of vitamin K and taking warfarin will have on the bones. It may protect from osteoporosis but then again it may not. One thing is sure - the more vitamin K you take in, the higher your warfarin dose will have to be to maintain the same INR. I agree with eating the healthy diet and adjusting the warfarin dose around it, but this is mainly because the healthy diet prevenbts eart disease. Whether or not any diet can prevent osteoporosis is unknown.

To complicate the whole picture of calcium, bones and warfarin consider this. The UK has a registry of maternal deaths and birth abnormalities going back into the 1950s. The nose is ordinarily composed of cartilege. Children born to women who took warfarin (maybe only high doses) during weeks 6 to 12 of their pregnancy have noses made of bone. The cartilege calcified. Their noses do not grow throughout their lives.

 

[Nancy]

While we're talking about calcium, I have a question that always puzzles me. I know that calcium needs vitamin D with it, but I also know that there is a limit on the amount of vitamin D one can take.

Most people take vitamins with vitamin D already in them, usually 100 percent of what you need in a day. Then if you add calcium with vitamin D in it, it will throw you way over the limit.

Does one take the calcium without vitamin D along with the vitamins with vitamin D. Will that work? And if you are going to take calcium three times per day, is the one vitamin pill sufficient for the amount of vitamin D that is needed?

Or does one take the calcium w/o vitamin D and wash it down with milk which has vitamin D. And then I guess you have to add something like orange juice.

 

[Emma]

calcium tablets???

calcium tablets???

I was planning on asking this at Chloe's next cardi check up next month (scared about it already!) but wondered if anyone here might know the answer first since we're on the subject.

Chloe does drink a LOT of milk, eats loads of dairy stuff - yogurts, cheese etc, but would it be worth her taking calcium supplements too, to try and combat possible bone density problems later in life?? Or would that just cause more problems than it solves??

Thankyou
Emma
xxx

 

[Marge]

Blanche, I think your explanation is very clear, and I thank you.

You wrote:

<<Coumadin neutralizes the Vitamin K that you ingest and the vitamin K that your body makes in the intestines. As a result, by definition those who take anticoagulants will always be deficient in Vitamin K because this Vitamin is "blocked" by anticoagulants.>>

So, should most people who are on warfarin/coumadin be taking Fosamax (or something) in order to ward off osteoporsis? I will talk to my PCP when I see him next month about whether I need to do anything about this -- have a bone density scan, or something. I hate the idea of having to add yet another drug to my mix.

Gosh -- one more thing to be concerned about on top of all the other things to do with warfarin? (I KNEW I didn't want to have to deal with this drug, LOL!)

It seems odd to me that neither my cardiologist nor the Kaiser anti coagulation clinic mentioned a possible osteoporosis issue. (And, yet, the anti coag people were so meticulous otherwise, and the informational packet they sent me seemed so thorough!)

 

[Blanche]

Osteoporosis prevention

Osteoporosis prevention

Marge:
Al has been taking Coumadin for nearly 15 years. No doctor, nurse, dietician, or any other medical person has ever discussed osteoporosis and anticoagulation with him. Never! My new doctor suggested a bone scan for me because of my age and I asked if Al should have one too. That's how his osteoporosis was found.

I don't think that doctors use Fosamax as a preventive medication. It is usually recommended after a bone scan indicates bone loss. It is my strong feeling that every woman should have a bone scan after menopause and that folllow-up tests should be scheduled on a regular basis. This is because the greatest loss of bone mass for women follows menopause. I had asked other doctors for bone scans earlier in my life, but all said it wasn't necessary and it was expensive. We have now found that neither reason is true. If we did not have insurance, my last scan would have cost $145. It is another firm belief of mine that all people should be aware of the reality of osteoporosis and take calcium and Vitamin D with magnesium and boron.

You may not need more drugs, but you might want to discuss osteoporosis prevention with your doctor. If I knew then what I know now, my osteopenia may well have been prevented. Perhaps the following will be of some interest to you and others who have these concerns.

http://www.radiologyinfo.org/content/dexa.htm
http://www.age-matters.org/osteoporosis.htm
http://www.spine.org/articles/osteoporosis.cfm

Blanche