Dexa Scan results

Thank you Eileen!

The Rheumie wanted me to start Alendronic Acid last year, but I have a problem with a tooth that a previous dentist tried to do root canal work on but couldn't manage it. There is therefore the possibility of it having to be removed in the future and I was worried about being on AA. So, I only took it twice and have been waiting to get these results to see if I am actually into the realms of Osteoporosis. 

Ach! These are not the results I was hoping for. All the worse because they were from last September when I had been on Prednisolone for only 2 months, so I must assume that the steroids have made them worse by now. I don't know how quickly they do damage.

My vitamin D result came back today. It's 53 which seems to be a bit low from the figures I have seen.

i suppose I must take the AA.

A dentist I saw last week made it clear he would be unhappy considering an extraction if I've been on AA. Don't know what to think because I'm not having the tooth out in the near future. 

 

Discuss the tooth with your dentist - at length. Does it need removing? What are the chances of it needing to be removed? Because I don't think any rheumy will be too happy at you not taking some medication with readings like that. If it is any consolation - I doubt the entire damage was done in 2 months of pred. Your osteoporosis was already there and should really have been identified earlier. The densities don't change overnight, the majority is felt to happen in the first few months so that should be a baseline but it takes months for significant changes to be identified. Even when on pred, according to the rheumy who refused me a second dexascan jsut a couple of months before the 2 years was up!

I wonder if your doctor would consider the teraparitide - it has been used to treat osteonecrosis of the jaw which is the fear on the part of dentists I think in relation to bisphosphonates. And your lumbar reading is pretty low.

Eileen do you think it's possible to increase bone density naturally through diet and exercise? I definitely have steroid-induced osteoporosis but am now down to 3 mg pred and hoping to come off it altogether in a few months. My feeling is that if you can only be on biphosphonates for five years anyway and I am only just sixty I could try natural methods for two years and if there is no improvement start taking alendronic acid then. I just hate the thought of an alien substance in my bones which will be there for life...

It is - nordic walking has a good record I'm told and can actually be associated with an increase in bone density. The main problem is that at our age it is difficult. 

However - there is some dispute as the the value of increasing the bone density. Low bone density ISN'T necessarily associated with fractures, people with normal readings can have fractures, people with low readings don't always do so. It is avoidance of other risk factorsthat is important - which I've preached loads of times about! Rugs on slippery floors, trailing cables, poor lighting, handrails on stairs, wearing shoes not fluffy slippers in the house, keeping muscle tone and balance good and BP in a good range (i.e. not overmedicating on the ground very low is good), keeping hydrated and keeping vit D at good levels all contribute. I'm sure there are others I haven't mentioned. 

Dinah, are your results similar to mine? I too have been worrying about taking AA? I will speak to my GP next week, but I have a pretty good idea what her response will be...

About 'it being difficult for people our age' Eileen. Do you mean to do the Nordic Walking or do you mean increasing the bone density?

Hi Sheila - yes my results are fairly similar. When I had scan two years ago, having been on steroids for a couple of months I had ostopenia in hips and legs and osteoporosis (-2.6) in spine. On my last scan a month ago the ostopenia had progressed to osteoporosis (average -2.2 in hips from 1.2 previously) and my spinal score had increased to -3.1

My Exeter rheumatology had said there was "no point" in having scan after two years as results weren't reliable. But the first thing my new consultant said at Guys was that as I had been on steroids for over 18months I should definitely have another bone density scan, but that it was important for it to be on the same machine. So my GP organised it, no problem. I think you should be fairly insistent with your GP about it. 

Re alendronic acid - I saw one GP who was sympathetic to my feelings and agreed that if I was off prednisolone there probably wouldn't be too much change so I could try diet and exercise and then have another scan. But that I should make a "positive" decision either way. The GP I saw this morning felt I really should take the alendronic acid. I am going to ask my consultant's advice at my appointment in a couple of weeks.

I have to admit I did fall and fracture my wrist in January - but I fell really heavily on to my outstretched hand and my son, who is a doctor, said lots of people without osteoporosis break their wrists in that situation.

Hi Eileen. I had a Bone densitronomy DXA scan 2nd Feb 2015. Because rightly or wrongly I thought that after 4yrs. I had been on Alendronic Acid for long enough and stopped taking it 3 months ago.Saw my GP this morning to "Discuss scan report", his wording. He is as confused as I am and suggests that I see my rheumatologist for a clearer explanation of 'T' and 'Z' scores. I see RH in about a months time luckily. In the meantime herewith a brief rundown of the figures from the Consultant Radiologists report. Do you know what a 'Z' score is?

Lumbar spine:- T Score 7.7     Z Score 9.0

Left Total Hip :-T Score 1.5      Z Score 2.6

Given the above results the patient has Normal Bone Mineral Density.

The report finishes with "WHO criteria for BMD interpretation classify male patients as Normal" 

So I guess that as an 82 yr. old male I am 'Normal'.

I would be very interested to know your thoughts on these scores.

Regards.

JanaPea

 

From my research recently, T scores are compared data to healthy adults and Z compared with older people.

 

That was all so helpful Dinah. More food for thought. Could wish this had been an illness that didn't require soooo much thinking, researching and deciding. However, as we keep rightly saying it could be worse, it is not terminal and it will all eventually pass...

Eileen I don't suppose you know how AA works?  How does it know where the low density areas are?.... 

Sorry - I clicked post and then realised it wasn't clear but OH decided he wanted to go out for lunch so I rushed away.

Building bone density - it can be done but is likely to be harder to do enough weight bearing exercise and the metabolism is different with the lack of oestrogens etc that also help build bone. That's part of why it becomes a problem post-menpause. The bisphosphonates don't build more bone, they just slow loss while bone is still being created. Only Forsteo actively builds bone.

Nordic walking courses are sometimes offered by AgeConcern and other groups like that. I'm waiting for NordicWalking UK to get back to me (ever the optimist, they called me while I was standing in a hospital ward waiting for my husband to be discharged, could she ring in a hour I asked, that was fine she said. Yeah right) but if you google them you'd find info about where you might find courses. 

It doesn't I don't think, it doesn't preferentially increase bone where it is needed as far as I know. So I assume decent bone gets denser and not OK bone gets closer to being OK. If you see what I mean.

Bone isn't a static substance - it is continually being broken down and rebuilt. This explains it quite well in ordinary language:

https://patient.info/health/bisphosphonates

"The T-score: The “young normal” or T-score indicates how your BMD compares to that of a healthy 30 year-old. Peak bone density is reached by age 30 and should ideally be maintained at this level throughout your life. As BMD decreases from this peak density, fracture risk increases. The T-score is in units of standard deviations (SD) and shows whether your bones are more dense (+) or less dense (-) than those of a 30 year-old. This is the most important value and the one that is used to interpret what your BMD means.

The Z-score: The “age-matched” or Z-score compares your BMD to what might be expected in someone your age and body size. Again, the Z-score is in units of standard deviations and shows whether your bones are more dense (+), or less dense (-) than what might be expected. At young ages, the T-score and Z-score values will be similar. However, since low BMD in older adults is common, an age-matched comparison may be misleading. The chart below indicates how BMD changes, on average, among both Caucasian & African-American males and females with age. BMD measurements of Asians and Hispanics are similar to those of Caucasian populations." 

The Z-score for us is pretty meaningless and is usually ignored.

The figures you've quoted don't have a plus or minus in front of them - do I assume they are positive values then? If so, they must be pretty good bone density!  I have never seen numbers like that - is that why your GP is confused?  If they were negative values, your lumbar spine would be pretty low density but your hip is OK:

"Normal Results

The results of your test are usually reported as a T-score and Z-score:

T-score compares your bone density with that of healthy young women.

Z-score compares your bone density with that of other people of your age, gender, and race.

With either score, a negative number means you have thinner bones than average. The more negative the number, the higher your risk of a bone fracture.

A T-score is within the normal range if it is -1.0 or above."

Not sure if that helps or not.

Hi Eileen, I am 75 years old and had my first BMD test in 4 years. I am not on any medication for osteoporosis since 2010 as I had been on Actonel for 5 years previously. My scores were worse than i 2010.  Lumbar Spine -4.0, left Total Hip -2.6, and Left Femoral Neck -3.1. How bad is this and what would you suggest? I have an appointment to see my doc, but not until December17th. I had to request a BMD test as my hip and back had been aching constantly. What do you think about Prolia? That's what the specialist suggested after Actonel, but it was fairly new in 2010 and I wanted to think about

it.

All of those are well into the osteoporosis range - and I have to wonder whether taking the Actonel (risendronate) ever did very much for your bone density. If the calcium and vit D levels in the body aren't correct (and vit D is very often too low) then the medication cannot work but although it says quite clearly in the data sheet that this is important most doctors seem to ignore it. 

Nefret on this forum has been on Prolia for the last couple of years and her bone density is now into the acceptable range - she has said in the past she has noticed no problems with it at all. Another (elderly) lady, not on the forum, I know of had also been on alendronic acid (another bisphosphonate) for years and her bone density was still very low in her spine and she developed fractures. She was also put onto Prolia, had no problems and everything improved so she was able to get back to the gym and dancing.

Many thanks, Eileen, I have read such conflicting responses from women who had the Prolia injections-some real horror stories- that I was hoping to use natural methods to improve bone density. I already take Calcium, Magnesium and Vitamin D and have a very good diet. Am thinking about buying a weight bearing vest, as I have read that they have helped many women with osteoporosis. Love the elderly lady," back to the gym and dancing"!!! Hopefully that's going to be me, although I haven't fractured yet -fingers crossed. Thanks again.

When you look around online it is the horror stories that abound - just like when we were pregnant when everyone told you the worst scenario story they had ever come across (or possibly not...). Women seem to enjoy terrorising other women - no idea why. 

I will always point out the downsides - where someone doesn't need it yet. I have nothing against someone being asked to try the various bone density medications WHEN THEY NEED THEM. You do really. But I will still try to present a balanced view: the vast majority of people do fine with most drugs. You only ever hear of the bad stories.

You have been on the "natural methods" track for years and you now have osteoporosis. The natural methods take quite a long time - if they work at all. Unfortunately, when it is particularly bad in the spine, there is always the chance of you developing spontaneous fractures in your vertebrae. You may not but the risk is far higher and they can be very painful, there is no getting away from that. 

If you google vertebral fracture due to osteoporosis the WebMD and Orthoinfo sites have good and simple explanations.

I too am really reluctant to take biphosphonates but accept that I am going to have to at some stage. (My mother, now 89, is now at a 90˚angle to the floor with one hip jutting out sideways. She has never been given a Dexa scan because her GP told her she couldn't have osteoporosis because she had never broken any bones. Ignoring the fact that she had lost a foot in height during in the last 8 years - undoubtedly due to stress fractures) So I am hardly in a position to lecture anyone else - but I really would caution anyone with proven, established osteoporosis to take bone protectors.

I have the Alendronic Acid waiting in the cupboard to be used - I am on methotrexate and Naproxen (came off steroids in September - yay!), and as I have been told I have to take Omeprazole to counter any possible gastric effects, I don't hold out much hope for the Vit D and Calcium tablets being enough.

Do you think it is worth going to see an osteoporosis specialist? I guess they are all going to say the same thing - try Alendronic Acid first. I'd happily pay for injections - but some of the possible side effects (bone lesions?) sound even more scary. So maybe I should just chance my luck and take the tablets. Sometime. Maybe my new year resolution.... 

My AP spine Z score was -1.3 in Jan 2013 and then two years later, during which time I had been on Predisolone , -1.8. My T score, however, was rather worse (this is comparison with young adult score I believe?) down from -2.6 to -3.1

In my position, Eileen, would you take the tablets and stop prevaricating? 

 

The Z-score is fairly meaningless, all that does is compare your reading to the average for someone of the same age. What I suppose it does tell you is that you are worse than average. It is the T-score that is the more meaningful and your readings are not good, -2.6 was already in the osteoporosis range and it has deteriorated considerably. 

I just told my husband what her GP had said and his face was a picture! I mean - could he see through skin and into bone? It is all too often that osteoporosis is found BECAUSE someone has a typical break - if she wasn't in a situation where she was likely to fall she'd avoid a break but the loss of height was a major indicator that her vertebrae were squashing due to increasing cracks. And a major indicator that osteoporosis was the cause. 

I would call the National Osteoporosis Society helpline (I'm assuming you are in the UK?) and ask to talk it through with them. I'm told it is an excellent service. They have all the facts and figures. Personally speaking, I'm not sure the AA will do the job for you - given the readings and family history - and you may qualify for one of the other options straight off. Anything that is classed as a bisphosphonate is going to be accompanied by the risk of avascular necrosis (so is pred by the way) and possible jaw problems and the risk of spontaneous fractures. That is why they are only to be used for a limited time. Prolia is classed as one (it is an injection too) - but people I have come across who have been on it had no problems and their bone density returned to "normal" quite quickly. The risk of "bone lesions" is associated with Forsteo - but there was no sign in humans halfway through a follow-up study, they were originally found in rats (not necessarily a good model for humans) and at massive doses comparitively speaking. 

Thanks Eileen. I miss your advice - it was the best thing about (not) having PMR!!!