To succeed in life, you need three things: A wishbone, a backbone, and a funny bone.”Reba Mcentire
For those of you who have been following along my scleroderma journey, you will already know that scleroderma is an autoimmune disease in which the body produces too much collagen, the build-up of which hardens skin and, in the case of systemic sclerosis, “the excess collagen can cause fibrosis in the heart, lungs and the muscles that line the gastrointestinal tract” (Scleroderma Canada website, www.scleroderma.ca, March 2019).
I have suffered from acid reflux most of my adult life so when I was diagnosed with scleroderma I did not readily attribute my heartburn to the disease, however, my rheumatologist urged me to begin taking medication. I was prescribed pantoprozole, a proton pump inhibitor (PPI) for relief and to prevent further damage to my esophagus. I have taken this medication for the last couple of years now, but recognize my triggers and rather than taking more medication, I try to avoid consuming too much of the foods and beverages that make the situation worse for me. Recently, my Gastroenterologist recommended I try a different PPI called Dexilant. When filling my prescription the pharmacist asked to speak to me about the new medication. One of the things she mentioned to me was that anyone who has taken PPI’s for more than a year should consider having their bone density checked.
I thanked the pharmacist and snapped-up my little white paper bag, rolling my eyes as I walked away thinking, “Now I need to worry about my bones too?”
PPIs and Bone Density
I don’t need to tell you how important our bones are to us! Bone density is a measure of their strength and a predictor of how easily they could break. Reminds me of a joke…
Son texts mom: Hey mom, going to be a little late for dinner
Mom texts back: What's holding you up?
Son replies: Bones! SMH
(Sorry, I know…)
I did a little research online, there seems to be some lack of harmony in opinion over the length of time on PPIs that could lead to bone density issues but, I did find a Safety Announcement from The United States’ Food and Drug Administration (FDA) from May of 2010 stating, “(the FDA) is revising the prescription and over-the-counter (OTC) labels for a class of drugs called proton pump inhibitors to include new safety information about a possible increased risk of fractures of the hip, wrist, and spine with the use of these medications.” However, the warning was updated less than a year later to exclude over-the-counter (OTC) PPIs. They went on to explain that, “The available data show that patients at highest risk for fractures received high doses of prescription PPIs (higher than OTC PPI doses) and/or used a PPI for one year or more.” (The U.S. Food & Drug Administration website, www.FDA.gov, FDA Drug Safety Communication: Possible increased risk of fractures of the hip, wrist, and spine with the use of proton pump inhibitors, March 23, 2011). While I only take a PPI once per day, it is stronger than OTC, so I supposed I should not second-guess my pharmacist.
I brought up the matter with my GP recently. She told me not to be too concerned, but that with my age and other potential risk factors, it would be wise to have a baseline bone density test performed. Requisition in-hand I booked the test before leaving the medical arts building. They were able to accommodate my test within a week, so not much time to obsess about it or to chicken-out!
The Bone Density Test
The bone density test, according to the (U.S.) National Osteoporosis Foundation, is the only test “That can diagnose osteoporosis before a broken bone occurs. This test helps to estimate the density of your bones and your chance of breaking a bone” (National Osteoporosis Foundation Website, www.nof.org, Bone Density Exam/Testing, 2019). The test is performed via dual energy x-ray absorptiometry (DXA or DEXA). According to RadiologyInfo.org, the the test requires less than 1/10th the amount of radiation of a typical chest x-ray and “less than a day’s exposure to natural radiation” (RadiologyInfo.org, Bone Densitometry (DEXA, DXA), 2019).
I had my test today! If you have never had a bone density test I am here to tell you that it is quick and easy. My experience was with a central DXA machine which looked at my spine and hips. The process is non-invasive, simply lie on a table and an arm passes over the areas they wish to scan. It is nothing like an MRI or other bone scan machines I’ve been in that can be difficult for those of us who are even a little claustrophobic; there is lots of open space between you and the scanning arm which never came close to my head or face. Even better there is no prep or any sort of dye injection required for this test.
Of course, you do need to remove most your clothes and bra (anything with metal). I mentioned that I suffer from Raynaud’s Phenomenon and the technician allowed me to wear undershirt, socks, and gloves as well as kindly providing me with a long-sleeved ‘house coat’ to go over the hospital gown. The only little hitch was my peritoneal dialysis catheter, it has a titanium coupler to attach the head. Fortunately, there was enough tubing that we were able to move the metal out of the image between shots. I was signed-in, changed, tested, and out of the lab within a half-hour!
Who Needs a Bone Density Test?
According to the Mayo Clinic’s website, Osteoporosis is most common in post-menopausal women of Caucasian or Asian descent and this risk increases with age. Another strong predictor is a family history of the disease. Finally, “Men and women with small body frames tend to have a higher risk because they usually have less bone mass to draw from as they age” (Mayo Clinic, www.MayoClinic.org, Osteoporosis — What are your risks?, July 2, 2019). As in my case, certain medications as well as health conditions will increase your risk of low bone mineral density. You can visit the Mayo Clinic’s website for more information about these and lifestyle-related osteoporosis risks (such as lack of calcium and/or vitamin D3 consumption/absorption, smoking and alcohol consumption) at Mayo Clinic, Osteoporosis – What are your risks? The website also provides information about medications for osteoporosis.
If you are taking prescription doses of PPIs from more than a year for scleroderma (or any other reason), or are concerned you may have bone density problems in the future due to other concerns, just speak to your doctor. Your physician will have a much better idea of your risk factors for osteoporosis and may order bone densitometry testing like mine did. If they do, don’t stress about it! It seems there is little to worry-about with this low-radiation test, it is a quick and pain-free process! If I could still cross my fingers I would, but here’s hoping that your bones and mine are, and will remain, nice and strong! If not, forewarned is forearmed as they say; your doctor can suggest measures to help prevent painful or debilitating bone fractures before they happen.