Mild osteoporosis DEXA scores: what would you do?

@prettyflower…. I have taken a year to learn , understand and feel good about my knowledge enough to now feel like I’ll take the very initial recommendation for meds. But I wanted to feel good about that decision rather than just blindly doing what I was told. And I figured who better to help guide me in the BEST med for me than McCormick. And his recommendation was the same as that first endo I saw … so kudos to that Dr!!

I agree with @ans that good integrative docs are hard to find and very expensive. Even the ones that are not great will charge you around $650 for the first appt. I've had many integrative docs over the years and most have had a similar approach. They put you through a battery of expensive blood, stool, mold, food sensitivity, heavy metal and toxin tests. I think some of these tests are valid but I'm not sure we all need all of them so if you do pursue this route, start small and targeted with your testing. The validity of food sensitivity tests have been called into question. A better and cheaper approach is to do an elimination diet of a single food of category like gluten or dairy for 4 days to a week and see how you feel. Then reintroduce for a couple of days and see how you feel. Almost all integrative docs will tell you to eliminate gluten if you have any type of inflammatory issue. Secondarily, they will advise you to eliminate dairy. In my case, after doing much research on my own, I eliminated those two things in my diet and my alopecia went into remission. So, it is helpful to figure out if any foods are causing malabsorption issues or inflammation.

Most integrative docs are not experts in osteoporosis so I think you're best bet is an appt with Dr McCormick. The fact that your bone density was stable after meds and then dropped might be a good thing to explore with him. He is knowledgeable enough to have a perspective on what tests to do to potentially determine a root cause, and recommend which medication might be best for you and at what point in time. And he's half the cost of an integrative doc.

My most recent appt with an integrative doc was with Felice Gersh who is an MD specializing in menopause, with extensive experience prescribing hormones. Since I've been on HRT for 5 years, I thought it would be a good idea to speak with someone knowledgeable to discuss dose and long term use. She charged $650 for the initial appt and $350 for the second appt (1/2 hour). I felt those two appts provided a valuable perspective and I agreed that a dose adjustment might be helpful. Of course, she tried to hook me in to becoming a regular patient with ongoing follow up as many of them do but I didn't feel it was necessary other than a check-in every few years perhaps. And commonly, she tried to sell me lots of supplements so I had to exercise discretion.

I would wait until the DEXA with TBS; however, if that DEXA is going to be on a different machine, which I am assuming it will, you will have the new TBS numbers but you won't be able to compare the DEXA to previous t-scores.

If you haven't already, and while you are aren't taking any osteo-meds, ask to have BTM (bone turnover marker) labs. My endocrinologist failed to order BTMs prior to prescribing bisphosphonates and after 1.5 yrs on alendronate, followed by 1 dose of zoledronic acid, I saw little improvement in my bones. When I started doing my own research, I learned about BTMs and that they should be ordered prior to meds (for baseline numbers and to see what is going on) and about 3 months after starting meds, to see if the osteo-meds are having the desired effect (if they aren't, you can then make an educated decision as to what course of action to take, meaning looking for another solution rather than continuing with serious meds that aren't working for you). Had my endocrinologist ordered BTMs, I confident that based on my BTMs I would never have been prescribed bisphosphonates. I think this because, after my first zoledronic acid infusion, I decided not to follow my endocrinologist's "expert" opinion and therefore did not get the 2nd dose of zoledronic acid that he ordered. Instead, one year to the day of my 1st zoledronic acid infusion, I had BTM labs, which showed that I did not have elevated BTMs. Granted, since I'd already taken bisphosphonates, there is a chance that even a year later the drugs were effecting my BTMs; however, I just had my BTMs tested again 2 years 1 month and 1 week after my one and only zoledronic acid infusion and my BTMs are still low. Additionally, I have hypothyroidism, and after having taken the bisphosphonates, I learned that hypothyroid generally lowers bone turnover (it also lowers bone formation which can cause a net bone loss) so bisphosphonates, which "work" by slowing bone loss, meaning they don't build new bone, probably were not the right option for me, which my endocrinologist should have known.

Going back to your DEXA with TBS. Generally insurance will cover one DEXA every other year for women over a certain age; however, once you have an osteoporosis diagnosis it will cover annual DEXAs. If you call the imaging center that did your last DEXA, you could see what they charge for just the DEXA w/o a radiologist report. I did that the year a had a DEXA with TBS so I basically had 2 DEXAs in one year, one week apart and I just paid out of pocked for the DEXA on my normal DEXA scanner. I did this so I could compare the data to the previous year--if you do this make sure you ask what it costs and make sure they understand you only want the DEXA that you are NOT going to pay for a radiologist to review it.

Same here with the hypothyroidism (Hashimoto's). My first addressing of osteoporosis (-2.5) was by my primary care doctor, and the Rx was for Fosamax. I wouldn't expect her to know about the bone markers, but I imagine she should/could have known about the relationship between low thyroid and bisphosphonates treatment. What bothers me is that the endocrinologist she referred me to later should have been aware of BOTH of these things instead of zeroing straight in on Prolia and citing insurance as the probable reason for that path. I hesitate to go back to her at all, but on the other hand I feel I haven't given her the full opportunity to bring things around. I was not as knowledgeable then as I am now. As far as the DEXA, I have new insurance now and am told they will cover it in my age group (over 50) in full as long as the doctor supports it. Good direction on the DEXA comparison, thanks!

@teb thank you so much. I've seen a lot of posts recommending a McCormick consult but after reading yours I'm so much closer. I have his smaller book. I want to read more of it before deciding to call. I also think the idea of inflammation could be on target, as over the last year I've developed what my PCP thinks may be fibromyalgia (I'm not sure about it), and the muscle and joint discomfort is affecting my motivation to exercise.

I think it's wise to do some more reading before making the decision for a consult. That way you can ask more targeted questions and hopefully get a better sense of the direction you want to go in.

I have had bouts of fibromyalgia. Not fun! Thankfully, I haven't had it in years but I can commiserate with how you are feeling. If you decide to give gluten elimination a try, just know that it has to be complete. Can't even have a little or it sets off the cascade. I used to be a big bread eater but after eliminating gluten, dairy and most sugar, I find that I don't even crave those things. I crave broccoli! (I know, I'm a bit weird that way 🙂 )

Problem is that there are few doctors proficient in handling this whole issue.

I am going to call McCormick's office and see how much it costs and how far out he is. I already know that the PCP knows very little about this. She did not even read my chart and tried to prescribe Fosamax when I had a periodontal event years ago when they were prescribing it to everyone older than 50. It is best to have the research and then find someone who will listen, apparently a rarity in Western medicine anymore.

@mannism Dr. McCormick costs $300 for the first consultation and $85 for 15 minute follow ups by phone. His book "Great Bones" is more current and has a lot of info in the first book as well as on meds. I also recommend Dr. Ben Leder's video on YouTube on "Combinations and Sequencing." If your DEXA's are mild, McCormick's books are helpful. If more serious, he outlines info on all the meds very thoroughly in his latest book. He took meds himself. His office is very busy!

Thank you. I think he can help me figure out what's what. I don't exactly buy into the limits on the DEXA because the numbers were just pulled out of air and never changed. No one knows what is normal for seniors because there are no baselines. And Merck got into the picture right after the DEXA appeared with Fosamax, which it sold to people who did not need it. I was one of those, and I had an expensive and painful periodontal experience.