Dear Barbara and Lactnetters:
       This is in reply to the situation with the 40 year old mother who has
been diagnosed with osteoporosis. I was diagnosed similarly while nursing my
daughter when she was 5 months old. There are posts in the archive from
February 2000 and after regarding this. Dexa scan revealed spinal and hip bone loss
in the osteoporotic range and osteopenia in the wrist. I had a history of
menses not returning for 2 to 2-1/2 years while breastfeeding and I wanted to start
cycling to begin building bone as well, but I did not want to wean my
daughter.
       No one has addressed the cause of my osteoporosis, but blood tests
revealed low hormone levels and based on my lack of menstruation I proceeded to
work on getting estrogen into my body.  Monitoring of treatment effectiveness
throughout these 4 years included dexa scan, hormone blood tests and the urine
Ntx test. Blood tests are not really accurate or good in this cirsumstance,
but my insurance wouldn't pay for saliva tests at the time and I couldn't afford
it. I am currently doing a saliva test now and working on getting
reimbursement for the cost. Saliva hormone testing is much better and can be done over a
month to evaluate hormone levels throughout the cycle.  Here is a link to one
lab that does these tests. Saliva hormone test to measure sex steroid hormone
levels, monitor hormone repl The Ntx test measures bone resorption with a
simple urine test. you want this value to be low to indicate that you are not
using up your bone.  Here is a link to more information on that. Assessing Bone
Rsorption via Ntx . The dexa scan is not accurate in short periods of time and
not really good for monitoring except at yearly or biyearly intervals.
       I have had significantly positive increases in bone density since
diagnosis which I will share for the sake of offering proof that my treatments
have worked. Keep in mind I have had to research myself and fight the system
constantly to get these treatments and to continue to breastfeed. My 4 1/2 year
old is still nursing. I went through a few MD's to get the ones who would work
with me on this. They included experts on osteo, endocrinologists, who mainly
wanted me to go take bisphosphonates currently marketed as oral agents,
including alendronate, risedronate, and etidronate which are not contraindicated
during breastfeeding because of low oral bio-availability. Another choice would
have been selective estrogen receptor modulators, a class of compounds that are
estrogenic in some tissues and antiestrogenic in others. These drugs however,
did not address my hormone problem and produce minimal results compared to
what I am getting alternatively.
Spinal Bone Density Measurements
Feb 00 - .56,  Feb 01 - .591(5.5% increase since previous yr),  Feb 02 - .635
(7.5% increase since previous yr ) Feb 04 - .689 (8.5% increase since 2
years) TOTAL increase in 4 years 23%
Hip Bone Density also improved steadily with 1%, 3.2%, and 5.0% increases
respectively. TOTAL increase in 4 years 9.4%
Wrist Bone Density fluctuated negatively, but the amounts were insignificant
and probably reflected normal margin of error within test results. Changes
were -2.1%, -1.7%, and -0.6% respectively. DECREASE in 4 years 4.4%, keep in mind
this value has never been in the osteoporotic range. It is only considered
osteopenia so I need to gain less here overall.
       The first half year after diagnosis I used the following treatments.

Calcium supplement which includes Vitamin C 150 mg, Vitamin D-3 75 IU,
Calcium 750 mg, Magnesium 375 mg, Boron 3 mg, Glutamic Acid 120 mg. This is in 3
tablets - I take 6 per day. It is from Douglas Labs and is called Cal Mag 2000.
This formulas was recommended by my chiropractor based on evidence that it is
necessary to have adequate magnesium and D-3 levels for bone accretion.  The
glutamic acid is also there to aid digestion and absorption of calcium. (I
have had my gall bladder removed 12 years ago so this may be particularly
relevant for me.)
Boron is now being realized as a key element in bone metabolism. My MD only
recommended calcium, any form which would dissolve in vinegar in 30 minutes.  I
feel he was a bit off the mark on this. You can take all the calcium and just
get kidney stones if you don't absorb it. Also, I have had no constipation
with this formula as with others.  Therefore, no need for laxatives either. I
continue to use these now.

Exercise - aerobic optimally 4 to 5 times per week for 30 minutes and weight
training. I worked with a physical therapist for 3 months due to my fractures.
I attended back school to learn how to move and perform various physical
activities so as not to additionally harm my back. I also have continued to
exercise in this way.

Calcitonin Nasal (myacalcin) - slightly decreases bone resorption and is an
analgesic. Discontinued after the first year.

Natural Progesterone cream - some research has shown this to significantly
impact bone density.  John R. Lee, MD, author of "What your doctor may not tell
you about menopause," has promoted it for years. Discontinued after 1 year
because this was not enough progesterone to make a difference. I also briefly
used estrogen cream, but was allergic and discontinued it quickly due to skin
rashes.

After 6 months I began taking Allese, a low dose birth control pill
containing estrogen and progesterone. Within two days of beginning this I had total
pain relief. It was probably significant in achieving the increased bone density
reflected in February 01. However, it greatly reduced my milk supply. My one
year old gained no weight during the six months I took it and nursed
constantly. She also had some vaginal bleeding. I had breakthrough bleeding as well and
I did not like being on the synthetic product.

After 1 year I switched to natural estrogen and progesterone that I have
compounded at the pharmacy. This is was prescribed by my naturopath. For more
information about these hormones you can visit this site. My hormones don't come
from them, but are the same thing. Menopause and Women's Health.
Europahealth.com perscribes Cyclic Female Hormone  It took a year of paperwork, but these
are now covered by my health insurance with a small copay each month. I am in
the process of reevaluating my hormone levels with saliva testing after a
temporary cessation of hormonal supplements. I have taken these for 3 years and
there is concern about taking any hormone replacement although the risks don't
appear to be the same as with synthetic hormones. Still, I want to use them only
as long as necessary.
       I am considering the PTH injection, Forteo, as a second treatment
regimen to build bone since I am now 45 and getting close to menopause. I want to
build as much bone as possible before then. This treatment was not yet FDA
approved in 2000, but now is available. There isn't much research on concurrent
treatment regimens, but there is some using this along with hormone therapy
that looks promising. There is a great deal of new research on this drug now and
some indicates that it increases cortical bone, not just trabecular bone which
is a benefit.  If you go to this website and type PTH in the search bar you
can look at numerous studies. OBGYN.net - OBGYN.net - Osteoporosis Section:
News and Articles
       That is the briefest summary I can give of the information I have
regarding breastfeeding with osteoporosis. I would be happy to email or talk
personally with Barbara or the mom. Also, I am always looking for new information,
so please pass on anything you think I can use.
Judy Gutowski, BA, IBCLC
Western PA




             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html