i started writing this last night and passed out - in fact for quite a long sleep. 

so, i've now slept on it.

thinking back, i think i've had longstanding skeletal concerns for many years. my diet is about as good as i can make it, i've always had a high calcium diet and i've been cognizant of d for roughly the last five years, but i remember walking to get groceries and feeling like my legs were going to snap, as long as 15 years ago. 

the reality is that i grew up in a heavy second-hand smoke environment, which is the single greatest risk factor for developing osteoporosis later in life. and, i smoked, myself, off and on, but nonetheless, for about 15 years, as well. i've also been known to eat every two or three days for weeks at a time.

so, i can't really jump to conclusions regarding this switch to generic estrogen, because i don't have the baseline. further, the last dentist i saw was adamant that the recession was not recent. it's also worth noting that my alp numbers were normal, although i should ask about pth and also about osteocalcin. together, these can help me understand if the bone loss is recent and ongoing or the result of growing up in a second-hand smoke environment, of smoking as an adult, of a poor diet years ago or perhaps even as a result of malnutrition as a child.

i should behave like it's the cause, regardless, though, and treat myself as though it is.

so, should i take vitamin d, then?

well, if i was concerned about normal dietary consumption, i'd say "no". i should get enough...

but, what i want to do right now is bombard my bones with as much d as i can take...it's ideally temporary, and it might not work at all, but i sort of have to try.

and, if these tests for colitis and etc come back positive, i could be experiencing some difficulties absorbing it and need the extra supplements. right now, it seems ok, but...

so, i asked my doctor to fax an rx to the pharmacy for d and i'll pick that up tomorrow. but, i'm looking through the formulary and just flat out cholecalciferol isn't there. it seems like i want this:

ALENDRONATE & CHOLECALCIFEROL Apo-Alendronate/Vitamin D3 70mg & 140mcg Tab

....which is covered. at least for now. but, the side effects of the alendronate look vicious. like....it might work to prevent bone loss, but you're going to severely damage yourself in the process. and, the fact that they'd use such a disruptive medicine suggests it's the best we've got.

looking into this, there's some chance that the osteoporosis is a symptom of some other type of cancer, like breast or lung cancer - or blood or bone cancer. i want to at least clear that before i start taking crazy meds like that.

the other option is 8000 iu/l of vitamin d2, which is too much.

so, i may need some back and forth on that. but, it looks like 1000 iu/l of d3 is less than $10 and that's probably an easy, fast first step.

and, calcium?

calcium seems to be less effective, and i think i'm doing ok. while the d came in "lowish" but normal, the calcium was actually pretty high. and, high calcium apparently creates heart problems and just ends up as kidney stones, in the end. if they insist, fine, but...

(high calcium serum levels could also be evidence of bone loss more than evidence of sufficient absorption, though)

i'm also going to contact the endocrinologist directly and ask him about immediate injections. there's another medication called calcitonin that is covered and seems to have less vicious side effects than the alendronate but you have to inject it. it also seems to be estrogen based. so, what's the best approach here - estrogen injections or calcitonin?

and, i should go back to walking to the store rather than biking...

the thing is that all of these approaches can only try to stop loss. none of them can reverse anything. and, these numbers are terrible - i need some way to reverse it.

one thing that may increase bmd is fluoride pills, but you apparently have to get to it early in order to make a difference. am i early enough? well, it's osteopenia and not osteoporosis, so probably. there's also some suggestion that messing with your thyroid hormones might help, as they seem to be directly responsible for calcium metabolism. but, the only really serious way to do this is probably via gene editing, and, once again, i'm stuck waiting and hoping we get there.

so, i should test for the following hormones and markers to try to grasp whether the loss is ongoing or historical:

- pth

- calcitonin

- oseteocalcin

- igf-1

- cortisol

- balp