Wednesday, February 23, 2011 Terry Vallely asks

Q: Should I get a second DEXA scan?

I am 50. I went through menapause 2 years ago. I had my first DEXA in November 2010 and the results showed Osteoporosis in my hip and femoral neck (T scores -2.1 and

-2.8). My spine average t scores showed Osteopenia ( L1-L4 -2.4. I find the results hard to accept. My doctor wants me on medication immediately ( Actonel once a month)

I am very healthy and exercise 5 days a week. I am 5"9 and weigh 159. I do not smoke or drink. I take vitamins and calcium supplements. My Calcium and Vitamin D levels tested normal. there is no family history of Osteoporosis in my family except for one maternal aunt diagnosed at 78.

The only known health problem I have is a mild protein S deficiency which has not been a problem except during pregnancies. (I take a baby asprin each day to be safe.)

I think I should have another DEXA but 2 docotrs have told me it won't show anything different. What do you think?

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Answers (2)

Pam Flores, Health Guide

2/23/11 6:52pm

Hi Terry, welcome...Sorry to hear about your dxa! I know how you feel, there are many in a similar situation like yours and they can't figure out how the bone loss happened.

My first thought would be, have you been checked for secondary causes of osteoporosis, because there are many. Here's a list of secondary causes you can read about. There are also medications that can cause bone loss as well and here's a list of those. If none of these things apply, then I would ask for a Frax Score test, which you can fill out yourself if your dxa doesn't include this in it's software application.

Keep in mind, that a dxa in itself is not the only measure for bone loss. If you want to have another dxa and your insurance will pay for it, see if you can't have another, but be sure it's on the same machine and with the same tech so you can compare it. If you don't use the same machine/tech it's almost impossible to compare.

Also, if you haven't had a fracture you are doing well. Fractures are indicative of bone loss, especially if they are fragility fractures (fractures from a standing height).

Some people with low t-score may never fracture and that is the end point you want to avoid.

Talk to you Dr. if you think there is some mistake, but keep in mind that your Frax score will give you more info on your percentage of fracture risk. If it's low, then you may not need to worry, but something is causing this and if it's a medication or medical disorder these things can be treated seperately and should raise your score once treated.

Good luck

Michael

2/28/11 11:09am

Dear Terry,

Thank you for sharing your information.

I agree with the comment about seeing what your 10 year fracture risk (FRAX) will be to help you and your physicians decide whether treatment is necessary.

However, your calcium levels and vitamin D levels have very little to do with your postmenopausal bone loss (osteoporosis) and having another DXA test. The MD that told you it would not change is doing you a disservice. Women within the first 5 years of menopause will continue to have bone loss. It would be worthwhile to see how your results will change ...because the bone density especially in your hip regions are critical to watch. It's very important to maintain a calcium/vitamin D diet that provides at least 1500mg of calcium and 2000IU of vitamin D3. (Please do not confuse 1500mg of calcium to mean supplement...try to determine your calcium intake from food (milk, yogurt, cheese, leafy green things, etc.) then supplement to get to 1500 if your not there already).

Your could ask you MD to check out your bone biomarkers that can be measured in the blood and urine...these factors can tell him/her how fast you are losing bone.

However, get the second scan as a monitor of change...IT WILL BE worthwhile.

I am the Director of an Osteoporosis Center near Chicago and I have this non-believing conversation often. Just remember it's never too late to stop bone loss and it's easier to do it now rather that wait for your skeletal architecture to weaken further. Also, having osteoporosis does not mean you are going to fall apart, but it does imply that you have a high risk for fracture...the biggst risk being a fall.

Best of luck and feel free to send me an email if need be.

Sincerely,

Michael

Q: Should I get a second DEXA scan?

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