" The back bone, is connected to the neck bone... "

"The Back Bone is Connected to the Neck Bone..."

Asthma and osteoporosis and bone density.

I had been avoiding it for such a long time note: do not be like me and get a bone density, right away! Ironically, last fall I went two rounds with my family doctor about a referral for a bone density study. His reply was that we would do this at my next visit. I am not sure when exactly he thought that my next visit was going to be? However, the discussion was a bit dismissed, and I was miffed but I carried on my merry way, to bring it up next time…. This is an example where I had an advocacy fail! I should have stood my ground and demanded, it is part of the nuance of doctor-patient relationships.

In contrast, at a recent appointment, my respirologist asked me when the last time I had a bone density was and it had been years….yikes! This escalated my need for one. Especially, when my respirologist was significantly concerned that it had been such a long time since I had one and that I most likely had bone loss that should be addressed.

Need for guidelines for bone density screenings for asthmatics

Interestingly the guidelines on the intervals at which screenings should occur are very vague. You may be asking yourself, What is a bone density study? A bone density study or densitometry (dexa) is similar to an x-ray. It uses small amounts of ionizing radiation to create images, usually of the spine and hips.

Why is it important in asthma? They are important for the early detection of osteoporosis. Asthmatics are at risk due to the use of oral glucocorticoids that are prescribed for treating inflammation. Oral glucocorticoids are thought to decrease calcium absorption from food, increase calcium loss from the kidneys, decrease bone formation and id form loss.2-3

Asthmatics who have been on steroids may have their risk for osteoporosis categorized in three main groups4:

  • Low risk - beclomethasone in doses ≤800 µg/day in adults or ≤400 µg/day in children.
  • Medium risk-patients receiving inhaled steroids in doses >800 µg/day in adults or >400 µg/day of beclomethasone in children.
  • High risk- take systemic steroids at least four times a year. The last group also includes patients receiving combined therapy of inhaled, topical and oral steroids.4

Regular monitoring of bone loss is important for early detection and treatment of osteoporosis. I personally don't want to have to treat yet another comorbidity so If I can get ahead of this one. I would be grateful. The actual testing is quite simple and I will be keeping my fingers crossed that I have limited damage. I want to be as healthy as possible. I already have silly lungs to deal with and I  don't want to have any more impacts on my quality of life. I will also be working on my bone strength by increasing my weight-bearing exercises. I am making that my summer goal.

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