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Osteoporosis, compression fractures due to sleep walk - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Osteoporosis
Answered by

General & Family Physician
Practicing since : 2009
Answered : 667 Questions
User :   I'm a 40 year old that was just diagnosed with osteoporosis in my lumbar spine. The find was made when I fractured two vertebra in my thoracic spine (T4 and T5) after an "episode" at night. I have a sleep disorder, that every once in a great while, I'll wake up and sleep walk and cannot be awaken for 45 minutes to an hour. I have injured myself during these episodes. I've dislocated a shoulder, broke a wrist, and now have fractures in my spine. I was in the army in 1996 when the first episode occurred after a fall out of my top bunk and five feet down onto the floor (having a grand mal). I was diagnosed with epilepsy (only nocturnal seizures), but they happen only every few years, and they really aren't shaking seizures, but more me being in some sort of state that I cannot come out of. I've had sleep studies, and they have been "irregular". I started taking Dilantin (300 ml a day) in 1997 and took it for about 6 years. I discontinued the medicine, for concerns it was damaging my liver as many long term medications can do. I didn't realize another side effect to Dilantin is significant bone density loss. I am a chiropractor and have a good understanding of bone, but I'm also fairly new and don't have all the answers. I consulted a family friend that's a DO (over 30 years) and he said a 40 year old male with osteoporosis is rare (although a Google search suggests it's on the rise). I already know and have increased Vit D and Calcium intake (I have not had a good diet most of my life, and rarely eat vegetables). I also know I must do weight bearing exercises.. I'm not as active as I should be. The DO also suggests I may have an endocrine problem. I had a blood test done approx 10 months ago for life insurance and some of my liver values were on the borderline. I'm thinking perhaps my problem stems from a poor diet AND poor absorption of the little bit I've taken in over
User :   a long period of time. I guess what I'd like to know is... is there any test that someone here would suggest that I haven't done? I've had an MRI of the thoracics, which suggests an acute injury. I've had a bone scan (nuclear med) which suggest a chronic problem and I've had a DEXA scan which suggest osteoporosis in the lumber region (-2.6 T score; -2.5 Z score and in the L femoral neck -1.6 T score; -1.1 Z score.. for Osteopenia). Any medication you would suggest to treat this? Had a blood test 7 days ago, and haven't received results back yet (VA Hospital). An specific part of the blood test I should key on? Any specialist which I should see? There reason I'm being so complete with this, is I really don't want to go through this the next 10 years, and find out... if I just would have done this, everything would have been fine. Thank you, XXXXXXXX XXX
Doctor :   hi
User :   hello
Doctor :   Dr. XXXXXXXX here.
Doctor :   let me read what you have typed
User :   okay
Doctor :   what were the recent blood tests done for?
Doctor :   for which you awaiting the results
User :   they were looking to see what caused the fractures
User :   I was a little concerned... perhaps pathological fx's
Doctor :   yes they could be pathological Fx due to teh osteopenia
User :   yes, but I'm wondering why I have osteopenia...
User :   my mother claims she does not have osteoporosis... she's 62.. but she may
Doctor :   there could be the reason due to your medication use
Doctor :   what medications are you taking at present?
User :   Dilantin...
User :   I know it's known to decrease bone density
User :   i stopped taking it 5 or so years ago
User :   because I was worried about liver function
User :   the DO who's a family friend, said I should have "recovered" from any damage the medication did after 5 years
User :   of not taking the medication
Doctor :   what medications are you taking at present?
User :   I wasn't taking anything... until I had the seizure a month ago.. then I started taking Dilantin again... and now they've raised it from 300 ml per day to 400 ml a day.
Doctor :   ok
Doctor :   i would suggest you to wait for the blood results
Doctor :   see what tests they have already done
User :   and what would you look for in those results?
User :   liver issues?
Doctor :   and discuss your symptoms with an orthopediacian who will be better to answer your doubts
User :   Have you had any patients that were young men with osteoporosis?
Doctor :   yes, they are young men with osteoporosis, especially with medication use
Doctor :   are you stil taking calcium and Vit D supplements?
User :   Do you know if simply upping Calcium and Vit D intake CAN take me out of the range of osteoporosis? (if there isn't an issue with absorption)
User :   I recently started taking the cal and vit d... about a month ago... right after the episode
Doctor :   if there isnt any issue with absorption then it should help
Doctor :   however, you need a complete evaluation under supervision of orthopedician
Doctor :   and neurologist for manging your symptoms
User :   It's been a month, and I feel quite a bit better... I was about a 6 to 7 on the borg daily, but it's now down to a constant 1 to 2.
User :   Yeah, I have a neurologist that's been checking.
User :   I was looking for medications that may help with osteoporosis in young men... I came up with Alendronate through XXX. Do you happen to know of any that might help? They are uncommon for men.
Doctor :   that is given when there is an absorption also is an issue
User :   It's something... me going to work and working on people with back problems, and here I've got osteoporosis at age 40 as a male with compression fractures.
User :   Okay, so what will I be looking for in the blood report for absorption problems?
User :   Are there any I should key on?
Doctor :   those would be special tests done. And I do not know what tests your treating doctor has ordered for you. do you have the list of test that were ordered for you?
User :   no... they just did a simply blood test. Perhaps they ordered something special... I'm not certain. They did take 4 tubes of blood... is that the norm?
Doctor :   they might have ordered some special tests, wait for the results to come.
Doctor :   then we can proceed further with what could be causing you the symptoms.
User :   Like I said, I've had several other tests done... MRI... suggest fx's are acute in spine... had bone scan... suggest fx's are chronic... DEXA scan... suggest osteoporosis and osteopenia.
User :   Okay... I'll try and get as much info as I can about the blood tests. I guess the diagnosis of osteoporosis beats out the diagnosis of cancer.
Doctor :   so with these further blood tests results correlated with the symptoms and previous tests
Doctor :   should give the answer.
Doctor :   get a copy of all the tests done
User :   thanks... that's it for now I guess.
Doctor :   you can also take a second opinion from our panel specialists once all your results are ready
Doctor :   you can send then to us along with specialist consultation request
Doctor :   http://XXXx
Doctor :   visit this link to consult with any one of them
Doctor :   you can send us your reports to XXX.XXX for us to forward them to the specialist.
User :   everyone I've talked to about this problem has pretty much said the same thing and confirms what I've been thinking. I just want to make certain that I'm not missing anything... and down the road someone says... you really should have done XXXXX.. then you'd be okay
User :   will this chat be emailed to me so I can print it out?
User :   do you know?
Doctor :   without proof of investigations we cannot pin pint your diagnosis
Doctor :   and nothing can be said for sure
Doctor :   so unless there is proper proof, then only teh treatment can be advanced in right direction
Doctor :   you can get the caht transcript
Doctor :   by going to 'accounts and setoings'
Doctor :   and clicking on 'chat history'
Doctor :   *settings
Doctor :   and export this to your mail ID
Doctor :   have you followed what I have said?
User :   yes... I'm good... have a good night... or good day... where ever you may be
Doctor :   is there anything else I can help you with?
User :   no thanks
Doctor :   thanks for consulting me. bye for now. all the very best.
User :   bye
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