I vividly recall bouncing on my grandmother’s small lap as she sang “Five foot two, eyes of blue” into my ear. She loved that song – my grandfather courted her with in back in the early 1920s.
There was a pervasive standard of beauty that celebrated tiny, birdlike women a hundred years ago. My grandmother, who fit that bill, took full advantage of her moment in the sun. Size five shoes, impossibly small wrists, she was barely 5’2”.
My grandfather was smitten.
My mother was 5’4’’, I was once 5”6 ¾. We all have those tiny wrists – mine is 5 ¼” all the way around. My feet are a European 37/US 7.
By the time she died, my grandmother was 4’ 11”.
Somewhere in the early 80s, while my mother was still alive, a new medical term started appearing all over the news – osteoporosis. From the descriptions blaring over the television, it seemed clear that my grandmother had it. Mom and I made her go get checked. Indeed, she was at high risk of fracture, but was not a candidate for any of the oestrogen replacements offered at that time due to her history as a breast cancer patient. My grandmother became increasingly fearful of falling and fracturing something. She shrank further as she stayed bent to look at the ground while she was walking. We tried to get her out of her heeled shoes and into some sneakers, but her heels no longer rested on the ground and sneakers were very uncomfortable for her. She resisted any help that was offered, firmly and clearly. Mom and I gave up.
I was 25 years old in 1984. Since then, osteoporosis, like the sword of Damocles, has been hanging over my head. I took pounds of calcium supplements. I ate right. I exercised regularly (still do.) And yet, as a tiny little white woman with a family history of osteoporosis, I knew it was coming down the track.
American women of my generation remember clearly the actress Sally Field appearing on TV in the early 2000s, hawking the wonder drug that was Boniva. Just as clearly, we remember the debunking and loss to her reputation when it was revealed that Boniva increased the incidence of fractures of the femur, the strongest bone in the body. That class of osteoporosis drugs, the Bisphosphonates, terrifies many of us and is the primary reason for treatment resistance among women over 50.
There was a pervasive standard of beauty that celebrated tiny, birdlike women a hundred years ago. My grandmother, who fit that bill, took full advantage of her moment in the sun. Size five shoes, impossibly small wrists, she was barely 5’2”.
My grandfather was smitten.
My mother was 5’4’’, I was once 5”6 ¾. We all have those tiny wrists – mine is 5 ¼” all the way around. My feet are a European 37/US 7.
By the time she died, my grandmother was 4’ 11”.
Somewhere in the early 80s, while my mother was still alive, a new medical term started appearing all over the news – osteoporosis. From the descriptions blaring over the television, it seemed clear that my grandmother had it. Mom and I made her go get checked. Indeed, she was at high risk of fracture, but was not a candidate for any of the oestrogen replacements offered at that time due to her history as a breast cancer patient. My grandmother became increasingly fearful of falling and fracturing something. She shrank further as she stayed bent to look at the ground while she was walking. We tried to get her out of her heeled shoes and into some sneakers, but her heels no longer rested on the ground and sneakers were very uncomfortable for her. She resisted any help that was offered, firmly and clearly. Mom and I gave up.
I was 25 years old in 1984. Since then, osteoporosis, like the sword of Damocles, has been hanging over my head. I took pounds of calcium supplements. I ate right. I exercised regularly (still do.) And yet, as a tiny little white woman with a family history of osteoporosis, I knew it was coming down the track.
American women of my generation remember clearly the actress Sally Field appearing on TV in the early 2000s, hawking the wonder drug that was Boniva. Just as clearly, we remember the debunking and loss to her reputation when it was revealed that Boniva increased the incidence of fractures of the femur, the strongest bone in the body. That class of osteoporosis drugs, the Bisphosphonates, terrifies many of us and is the primary reason for treatment resistance among women over 50.
The train arrived at my station early after menopause. My bone density score took a plummet in my spine a year after I slipped down the stairs and cracked my sacrum. My wake-up call. It had been difficult to exercise during that year-long recovery, and the results of that were clear. I begged my doctor for another chance to get back to my health and bring my scores back to “just” osteopenia. I worked hard to do that, went on hormone replacement therapy, and I did it.
Four years ago, even with doing all the things I knew to do, I started to feel what I can only describe as a crackling in my spine. When I moved, it crinkled and crackled. It didn’t happen all the time, but when it did, I was acutely aware of it. I also noticed that it seemed to require all my Alexander Training to “think up.” Sometimes I’d see myself in the mirror and notice a bit of a hump starting just behind my forward head position. What in the world….
My next bone density test was just terrible.
My doctor begged me to start medication. Every fiber of my being was screaming “NO!” We had a clear discussion on the three classes of drugs she considered the best option for me. I agreed to think about it.
I went out to lunch with 10 friends to celebrate a gal pal’s birthday. When it came to my turn to talk about what was new, I took a deep breath and brought up osteoporosis. There were five other women at the table in the same dilemma. We were all scared to death – what was worse – the treatment or letting it go? Several others were on Prolia, an injectable with the least amount of side effects and they were all pleased with their responses to it.
Reluctantly, I went on Prolia. Three years later I’m back to osteopenia and my numbers have climbed dramatically. The crackle is gone. I have about 2 years before my doctor advises switching drugs. The rest of the options are not terrific. There are new drugs in the pipeline.
I watch and hope and continue to exercise.
Four years ago, even with doing all the things I knew to do, I started to feel what I can only describe as a crackling in my spine. When I moved, it crinkled and crackled. It didn’t happen all the time, but when it did, I was acutely aware of it. I also noticed that it seemed to require all my Alexander Training to “think up.” Sometimes I’d see myself in the mirror and notice a bit of a hump starting just behind my forward head position. What in the world….
My next bone density test was just terrible.
My doctor begged me to start medication. Every fiber of my being was screaming “NO!” We had a clear discussion on the three classes of drugs she considered the best option for me. I agreed to think about it.
I went out to lunch with 10 friends to celebrate a gal pal’s birthday. When it came to my turn to talk about what was new, I took a deep breath and brought up osteoporosis. There were five other women at the table in the same dilemma. We were all scared to death – what was worse – the treatment or letting it go? Several others were on Prolia, an injectable with the least amount of side effects and they were all pleased with their responses to it.
Reluctantly, I went on Prolia. Three years later I’m back to osteopenia and my numbers have climbed dramatically. The crackle is gone. I have about 2 years before my doctor advises switching drugs. The rest of the options are not terrific. There are new drugs in the pipeline.
I watch and hope and continue to exercise.
Osteoporosis is an enormous and growing public health problem. Once considered an inevitable consequence of ageing, it is now eminently preventable and treatable.
Ironically, despite tremendous therapeutic advances, there is an increasing treatment gap for patients at high fracture risk(…)Despite remarkable advances, concerns about rare side-effects of anti-resorptive drugs, particularly bisphosphonates, and the absence of clear evidence in support of their long-term efficacy is leading many patients who could benefit from drug therapy to not take these drugs. As such, there remains an important clinical need to develop ways to enhance patient acceptance and compliance with these effective drugs, and to continue to develop new drugs that do not cause these side-effects and have prolonged anabolic effects on bone.
-Osteoporosis Treatment: recent developments and ongoing challenges, Sundeep Khosla, MD and Lorenz C Hofbauer, MD, Prof , article published in “Lancet,” July 7, 2017.
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