Dialysis, transplants and wimpy bones

1-long-bones-femurWhen I was young, I used to joke about falling down.  You know the usual refrain: “Oops, fall down go boom!”  Now, after 15 years on the BigD, and two transplants, things have changed a little. These days it’s: “Oops, fall down go snap.”

How has this come about for a strapping individual like me?  Throughout our lives our bones are constantly being reabsorbed by the body and being rebuilt using two critical building blocks: calcium and vitamin D.  Until we are about 30, the process is positive or in equilibrium.  After that, our bones start to be reabsorbed faster that they are rebuilt.  At about 50 it is common to have a lower than average bone density (but still be healthy).

However, dialysis and especially transplants hasten the thinning process.  With transplants, our old friends prednisolone and cyclosporine-based anti-rejection drugs have a big effect, limiting the bone rebuilding process.  While there are no symptoms to bone density loss – though falls that result in a broken wrist (like mine!) or hip are considered good indicators – there is a test, called a bone mineral density (BMD) test, which uses low-energy x-rays.

In fact, transplant recipients losing bone density is so common that it is now a standard part of the transplant regime to visit to an Endocrinology clinic for a BMD test at least annually.

There are degrees of wimpiness in bones.

  • If your bones are just beginning to get thinner than normal, losing their density and strength, it’s called Osteopenia.
  • If you do nothing, it usually advances to become Osteoporosis.  Osteoporosis is where your bones are thin and fragile because you have lost bone mass caused by a deficiency in calcium, vitamin D, magnesium and other vitamins and minerals.  If it progresses, osteoporosis can lead to loss of height, stooped posture, humpback, and severe pain.  My mother certainly had it in the last few years of her life.

I had a BMD test a while ago, and at the last Endo clinic visit, I was told I had osteopenia.  The treatment is simple enough.  I take a calcium supplement, combined with vitamin D, every day.   Also, I must take regular exercise that involves weight bearing, like weight lifting, low-impact aerobics, jogging, and walking.  Luckily this is just what I do at the gym and when I go running around the block.  (While improved bone strength is a good motivator, I still find it hard to get out of bed early.)

I suspect that I’m in good company.  All around the world my fellow BigD and transplant osteopenias are dropping calcium and vitamin D and taking the occasional exercise to fight off the other Osteo.  Looking around the web, I found some great exercises at the Mayo Clinic for preventing osteoporosis.  We are not alone.

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