Mitigating bone loss after removing both ovaries

peggy_j · May 2017

I've been doing research and, unfortunately, it shows that women who remove both ovaries have more bone loss than other post-meno women, and that rate of loss continues for years. (One study showed an increased rate of loss, even 10 years after menopause). Has anyone had luck reducing this rate of loss? What did you do? I cannot take a bisphophonate. I remained on tamoxifen but even had loss

ShetlandPony · May 2017

1. Weight-bearing exercise.

2. Good nutrition and adequate vitamin D3 levels. Get a blood test for 25 OH-D and supplement according to your doctor's recommendation. There is a very interesting study where they used particular supplements in lieu of bisphosphonates. These micronutrients can be obtained from food, too: K2--Grass-fed butter and cheese, eggs, chicken, etc. Magnesium -- Dark leafy greens like spinach and kale, nuts and seeds, beans, etc. DHA -- salmon, sardines, etc. Discuss with your doctor. Abstract below.

Combination of Micronutrients for Bone (COMB) Study

"Along with other investigations, patients presenting to an environmental health clinic with various chronic conditions were assessed for bone health status. Individuals with compromised bone strength were educated about skeletal health issues and provided with therapeutic options for potential amelioration of their bone health. Patients who declined pharmacotherapy or who previously experienced failure of drug treatment were offered other options including supplemental micronutrients identified in the medical literature as sometimes having a positive impact on bone mineral density (BMD). After 12 months of consecutive supplemental micronutrient therapy with a combination that included vitamin D3, vitamin K2, strontium, magnesium and docosahexaenoic acid (DHA), repeat bone densitometry was performed. The results were analyzed in a group of compliant patients and demonstrate improved BMD in patients classified with normal, osteopenic and osteoporotic bone density. According to the results, this combined micronutrient supplementation regimen appears to be at least as effective as bisphosphonates or strontium ranelate in raising BMD levels in hip, spine, and femoral neck sites. No fractures occurred in the group taking the micronutrient protocol. This micronutrient regimen also appears to show efficacy in individuals where bisphosphonate therapy was previously unsuccessful in maintaining or raising BMD. Prospective clinical trials are required to confirm efficacy."

https://www.hindawi.com/journals/jeph/2012/354151/

ChiSandy · May 2017

You had bone loss despite tamoxifen because ooph. drastically reduced the amount of estrogen in your body. The bad news is that removing your ovaries doesn't mean you don't make any estrogen. Your fat cells (not the fat in the cells) and adrenal glands make an androgen called androstenedione. The enzyme aromatase, made by your liver, is the catalyst in a complex process that converts androgens to estrogens—which is why postmenopausal ER+ patients are prescribed an aromatase inhibitor (AI), which will reduce your estrogen even more drastically and—you guessed it—further weaken your bones. So what can you do?

At the very least, weightbearing exercise: it protects the long bones which are often the ones that get life-altering fractures. If you don’t have knee replacements that could get loosened, ballistic weightbearing exercises (running, jogging, jumping, rebounding) are even better. 1200 mg/day of calcium in a form you can digest (if you are on a PPI—I assume GERD is the reason you can't take oral bisphosphonates—you don't produce enough stomach acid to be able to absorb the cheapest form, calcium carbonate, so take calcium citrate); magnesium; 2000 IU of Vitamin D (you might need more—get tested); Vitamin K2 (not K). Jury is out on the safety of strontium—my MO recommends against taking it.

What if that's not enough, and your osteopenia gets worse (or you get osteoporosis)? You can take an I.V. bisphosphonate—Zometa or Reclast (same stuff)—which doesn't aggravate GERD--twice a year, but a twice-yearly injection of Prolia (denosumab, a “biologic") is quicker, has milder side effects, and recent studies show it's more effective in preventing or delaying the onset or progress of bone metasases. It's expensive, but more and more insurers are beginning to cover it.

But the micronutrients & exercise are the most essential. If you do nothing else, at least do that. (And include exercises to improve your balance, as well as take measures to make your home safer, to reduce the chance of falling).

ShetlandPony · May 2017

Hello, ChiSandy! We seem to be posting together today! You always give such great, detailed information.

To add my personal experience, even with an at-risk body type and six years of anti-estrogen treatment and permanent chemopause three years ago, I have managed to keep my bone density in normal range for my age, with no osteoporosis. I eat the types of foods I listed above, take 2000 iu D3 pills in two doses, and exercise (dancing, walking, yoga, and strengthening exercises), so maybe these things have helped me.

Yes, my onc felt iffy about strontium, so I ignore that one. She cited evidence that calcium supplements can increase the risk of cardiovascular problems without actually lowering the rate of fractures, and advised me to get calcium from food. I choose grass-fed yogurt and cheese.

peggy_j · May 2017

Thanks so much for the feedback! (And an FYI, I cannot take any bisphophonate in any form, due to a rare, 1 in a million bone condition that puts me at high risk for jaw necrosis). Yeah, I knew my oomph would reduce the estrogen but I imagined/hoped that the SERM would mitigate that. But perhaps it's not enough or perhaps my bone condition means my bone don't respond to SERMs like normal bones (we may measure bone markers). Or who knows? Maybe I'm not properly metabolizing tamox. (Has anyone gotten tested for that?). From my notes 2 years ago my endocrinologist said that SERMs can improve bone quality (vs. bone density). FWIW, last year I had a fluke episode of subaccuate thyroiditis (short-term hypothyroidism). Because it was transient in nature (fixes itself) and the hypo drugs are so risky, I was treated with a beta blocker but nothing for the excess hormone. So it's possible that depleted some bone. Oy. But that ended last fall. It's not a problem now.

My endocrinologist is a big fan of getting calcium from food vs. supplements. Part of me wonders if part of my problem was lifestyle issues. My mom was sick and I was out of town and stressed a lot for the past two years. My eating didn't go into the toilet but it wasn't the same as if I'd been at home. Do you know if daily walking for 30 mins is considered enough weight bearing exercise? (That's what I did on all those trips). Have you heard the concern about protein powders depleting calcium? I'm vegetarian and for awhile made a protein smoothie each morning but made it with oat milk that it fortified with calcium (35% RDA) and I took a multivitamin with a small about of calcium in the morning. So IMO I had a fair amount of calcium in my body when I took the extra protein.

Do you guys take supplements for Magneseum and K? My multi has 100 mg magnesium (22% RDA) and 65 mcg Vit K (Phytonadione) no RDA specified. I don't takeK2. (Yet?) Thanks for the commments on strontium.I'd been looking into that.

Pony, Thanks for mentioning the COMB study. I printed that out last week but apparently need to sit down and read it. Do you know what Vit D levels you are targeting? I've been taking supplements, spaced out through the day, and watching my level but my doc said not to go for the super high dose and to aim for a level between 30 and 65. He said no one knows the ideal range, maybe 30-60, and that there is no evidence that Vit D levels of 70, 80 or 100 are better (and Vit D is one supplement that can create problems if you take too much). One of my dentists, on the other hand, said to target the high end.

Mitigating bone loss after removing both ovaries

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