1. < Osteoporosis & Bone Health

Accuracy of DEXA Scans

Posted by njhornung @normahorn, Mar 9 7:07pm

I am guessing that I am not the only one facing a medication decision based on one DEXA scan with no fractures. That raises the question as to how much reliance we should put on that single measurement. I trust that sites calibrate the instruments according to the manufacturer's specifications. But we read about the importance of proper positioning. I was only asked to lie on a table with no special consideration of position. Does improper position make bones appear denser or less dense? Or is the effect minimal?

Remember the old weight charts that had ideal weight ranges by height and bone structure? Does DEXA factor in bone structure when calculating density. Obviously, there is less bone for the x-rays to penetrate for a fine-boned person than for a heavy-boned one. That could be interpreted has having less bone mineral density which may not be the case.

Any insight or other pertinent questions?

Interested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.

ripley | @ripley | Mar 11 11:00am
In reply to @rola "Summary would not allow me to photo or share link so copy/paste 😊" + (show)
@rola

Summary would not allow me to photo or share link so copy/paste 😊

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Interesting article. Regarding Bisphosphonates, "175 women must be treated for three years for each hip fracture prevented. Conclusion: The dominant approach to hip fracture prevention is neither viable as a public health strategy nor cost effective. Pharmacotherapy can achieve at best a marginal reduction in hip fractures at the cost of unnecessary psychological harms, serious medical adverse events, and forgone opportunities to have greater impacts on the health of older people. As such, it is an intellectual fallacy we will live to regret."

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ripley | @ripley | Mar 11 11:04am
In reply to @rola "Lol, Norma, good for picking the right finger!!! Exactly, there are so many variables, and of..." + (show)
@rola

Lol, Norma, good for picking the right finger!!!

Exactly, there are so many variables, and of course physical activity can cause injuries. I'm concerned with my hip, so I need to decide.

BTW, the price of this test was crazy high, I was shocked, nearly $900.

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What test are you referring to that cost $900? A DEXA scan?

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rola | @rola | Mar 11 12:02pm
In reply to @ripley "What test are you referring to that cost $900? A DEXA scan?" + (show)
@ripley

What test are you referring to that cost $900? A DEXA scan?

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Yes, my most recent DXA/VFA from Cleveland clinic in Vero Beach Fl.

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babs10 | @babs10 | Mar 11 1:22pm
In reply to @triciaot "I agree with your inference - I can’t quite make out how they came to their..." + (show)
@triciaot

I agree with your inference - I can’t quite make out how they came to their conclusion that one score fits all. Did you read the NIH link? - I’m not positive I caught all the info. It seemed they put more focus on whether the standard deviation, based on a 30 yo white female, could be applied to men (with larger bone mass). It also seemed that they recognized that the individual bone mass was different - I can’t help but feel it was implied that the physician would make a clinical decision on what “normal” was and adjust their treatment plan accordingly. Normal meaning an average sized white female - and if the patient is larger, smaller, different race, the score would be expected to be different. But I’m afraid that is not what is happening in a typical PCP or endocrinologist office.

The FRAX score is usually used as part of decision making for BMD treatment.
https://frax.shef.ac.uk/FRAX/tool.aspx?country=9
I find this a rather simple tool. It is also dependent on knowing whether there has been a previous fracture. My mother had undiagnosed spinal compression fractures that did not get diagnosed until the pain increased. Perhaps the tool is meant to capture clinically relevant fractures only.

My FRAX score barely met criteria for treatment. And based on my thinner bone, I may have had only osteopenia not osteoporosis. But, for me, the breast cancer metastasis issue is now a factor. And it pushes me over into taking Reclast infusions- at least until the risk of invasive cancer is lower.

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I have a T score for my lumbar spine, one for my femoral neck and one for total hip. Do you know which one I should enter into the FRAX tool?

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2 replies
Rubyslippers | @triciaot | Mar 11 2:40pm
In reply to @babs10 "I have a T score for my lumbar spine, one for my femoral neck and one..." + (show)
@babs10

I have a T score for my lumbar spine, one for my femoral neck and one for total hip. Do you know which one I should enter into the FRAX tool?

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Femoral neck for the FRAX tool!

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windyshores | @windyshores | Mar 11 4:59pm
In reply to @ripley "Interesting article. Regarding Bisphosphonates, "175 women must be treated for three years for each hip fracture..." + (show)
@ripley

Interesting article. Regarding Bisphosphonates, "175 women must be treated for three years for each hip fracture prevented. Conclusion: The dominant approach to hip fracture prevention is neither viable as a public health strategy nor cost effective. Pharmacotherapy can achieve at best a marginal reduction in hip fractures at the cost of unnecessary psychological harms, serious medical adverse events, and forgone opportunities to have greater impacts on the health of older people. As such, it is an intellectual fallacy we will live to regret."

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@riley which "pharmacotherapy" does that article refer to? And was this article clear on the T scores in the study? Does it mention efficacy in the spine? What is the date for that and does it predate better meds now available?

I remember reading something like that years ago and ideas like that probably contributed to reducing urgency for getting on meds (I did try) and to my ultimate fractures.

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njhornung | @normahorn | Mar 11 5:50pm
In reply to @windyshores "@riley which "pharmacotherapy" does that article refer to? And was this article clear on the T..." + (show)
@windyshores

@riley which "pharmacotherapy" does that article refer to? And was this article clear on the T scores in the study? Does it mention efficacy in the spine? What is the date for that and does it predate better meds now available?

I remember reading something like that years ago and ideas like that probably contributed to reducing urgency for getting on meds (I did try) and to my ultimate fractures.

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As @riley said, the number is for bisphosphonates and is from 2019.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6800121/#:~:text=Oral%20bisphosphonates%20are%20often%20considered,hip%20fracture%20is%20approximately%20200.

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windyshores | @windyshores | Mar 11 6:08pm
In reply to @normahorn "As @Riley said, the number is for bisphosphonates and is from 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6800121/#:~:text=Oral%20bisphosphonates%20are%20often%20considered,hip%20fracture%20is%20approximately%20200." + (show)

I need my glasses!

I remember reading that a few years back, probably before I went on Tymlos. I hope fewer doctors are prescribing bisphosphonates for osteopenia and early osteoporosis, and also that more doctors are starting with bone builders for more severe osteoporosis- if insurance will cooperate.

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rola | @rola | Mar 11 8:56pm
In reply to @windyshores "I need my glasses! I remember reading that a few years back, probably before I went..." + (show)
@windyshores

I need my glasses!

I remember reading that a few years back, probably before I went on Tymlos. I hope fewer doctors are prescribing bisphosphonates for osteopenia and early osteoporosis, and also that more doctors are starting with bone builders for more severe osteoporosis- if insurance will cooperate.

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Hey Windy, as I mentioned, "in time things change." Sadly bisphosphonates are still considered 1st line and this is 2024! So why treat hip fragility with a bisph? As you stated, we need to push for osteoanabolics (bone builders) first!

Evenity was introduced after this article, so I may consider it if my Dr will allow. She feels it's too new but I want the best drug to treat to target if possible. Her 1st recommendation was Reclast! Then I talked her into tymlos. I'm looking more to target hip primarily and am thinking Evenity. I'm just worried if there is a rebound effect like prolia? I am so dissappointed in the OP healthcare, they are so behind, and we seem to have to educate the Dr's.

Looks as thou the TBS score put me in a worse place than without it 😏. Did you get a chance to see my rept above, wondering what you think of it? ❤️

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rola | @rola | Mar 11 9:25pm

I really would like to do Tymlos first then Evenity buy I want the best results and not sure which way to go...

I was just reading this: 🤔 with same questions.

https://www.inspire.com/groups/bone-health-and-osteoporosis/discussion/evenity-or-reclast-after-tymlos-bone-building-or-maintenance/
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