Did my T-scores go down?

They all look better or the same except for L1 and femoral neck which are very slightly lower. But in my experience DEXA's jump around quite a bit even with the same machine. It seems like the report put it right: relatively stable. I was told a change more than 0.5 plus or minus is significant and those less than that aren't. So your L4 improvement would be significant by that standard. I was also told the femoral neck score is unreliable to assess change, not sure why. Do you have any fractures?

Does your doc want you on meds? My docs stay away from Prolia. You might be able to do oral alendronate-?

Yes the one stands out is L4 change. Have you ever been diagnosed of having arthritis or fracture at that level? If so it would falsely increase dexa reading. The other score maybe unremarkable. You could check bmd value changes for the 2 years and compare with LSC (least significant change at the footnote). If the changes are less than LSC, then the readings are within normal machine noise/error which means you don't have much change during the 2 years. You could double check with your doctor about this.

Your frax score is for major osteoporotic fracture right? If so, it doesn't appear to be very high. Does you doctor recommend treatment?

I need to sincerely apologize. I was on Fosamax for about 8 weeks. I had diarrhea and nausea and I was taken off it because of that. It was for brief period that it slipped my mind. I am unable to change the original post to include this information. Regardless I doubt that was the reason for the score differences.

I do not have fractures. My doctor wants me to go on Reclast. On a handout from doctor's office it says Prolia has lesser side effects and greater increase in bone mass. I was thinking of asking the doctor about going on Prolia. What is the reason your doctor wants to stay away from Prolia?

I need to apologize. I was on Fosamax for about 8 weeks. I had diarrhea and nausea and I was taken off it because of that. It was for brief period that it slipped my mind. I am unable to change the original post to include this information. I do not have arthritis or fracture.

Yes, the FRAX score is for major osteoporotic fracture. My doctor wants me to go on Reclast. I am a bit nervous about it because of the side effects. My friend went through couple of weeks of suffering.

Windyshores has many comments on prolia on this forum. Mainly it's very hard to get off it after 2-3 doses, unless you take it for life and without any ill effects. It's preferred to start with a bone building or anabolic drug (forteo, tymlos or evenity) first before switching to a bisphosphonate to lock in the gains in bone density. There are ppl with milder osteoporosis doing very well just being on a bisphosphonate for many many years. But for each individual, one wouldnt know if one belongs to that group. You were on fosamax only for a short period of time, likely going on a anabolic would work for you.

If you stop Prolia, there is a sudden and sometimes severe loss of bone density and increase in fracture risk. This "rebound" can be mitigated by going on Reclast. One expert, Keith McCormick, says that the timing of this transition is tricky and you need to do blood tests (especially CTX) to determine the best timing. Fosamax is sometimes used but not as potent as Reclast.

If I were 90 years old I would consider Prolia because there would be no need to come off... My doc jokes he might prescribe it if retiring so he doesn't need to deal with anyone getting off!

That said, it is a pretty effective medicine and Dr. Ben Leder in a You Tube video on Combinations and Sequencing talks about combining it with Forteo. The thing is, your scores aren't that bad, especially your hip.

Usually people do better with a bone builder (Evenity, Forteo, Tymlos) first. Not sure if you would get insurance for that, but worth a try. Reclast or Fosamax is used to lock in gains with those too.

Tymlos is very good with spine. Maybe you could do one year and save a year for later. You could do IV Reclast to save your GI system vs Fosamax.

I don't know much about male osteoporosis but you don't have to deal with estrogen deprivation, so maybe that is why your bones are pretty stable. I wonder if your doc would agree to you continuing as you are with some more attention to "whole body" approaches. You could look at McCormick's new book, "Great Bones" for further info.

Do you have GERD?

No I do not have GERD. I was a little scared when a friend of mine had pretty serious flu like symptoms after Reclast. He tolerated his second infusion much better. I think I will go with Reclast. At the moment my insurance is unlikely to approve anything other than Reclast.

Thank you very much .

Advice I have received for Reclast is to hydrate well, take tylenol and request a slow infusion. Many people do just fine. I was told to expect feeling fluish for a couple of days. It stays in the body a long time so we may be able to take breaks without meds.

If your L4 is arthritic, that could account for the appearance of apparent density, without any improvement having taken place. My L4 is no longer included in my spine score for this reason. That would be up to the doctor reading the machine printout to determine.

I have never been diagnosed with arthritis. The doctor interpreting the results has not noted anything. Following is the doctor's impression

"Bone density in the total lumbar spine remains in the osteoporosis range with a 4.0% increase in bone mineral density since 10/25/2021."

However, I will bring this up next time I see my Rheumatologist. Thank you.