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.

babs10 | @babs10 | Mar 11 11:09pm
In reply to @triciaot "Femoral neck for the FRAX tool!" + (show)
@triciaot

Femoral neck for the FRAX tool!

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Thanks. How would anyone know that? Appreciate the reply.

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windyshores | @windyshores | Mar 12 6:09am
In reply to @rola "I really would like to do Tymlos first then Evenity buy I want the best results..." + (show)
@rola

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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@rola your spine is slightly worse than hip, though the difference is probably not clinically significant. Tymlos is good for spine. You could do Tymlos for two years and by that time it may be more mainstream to do Evenity afterward. I had to convince my doc.

My idea was to do Evenity for just a few months, when it is a strong bone builder and before it becomes more of an anti-resorptive, so I wanted to do it after Tymlos, do a few months, then switch to Reclast. My doc told me I am creating my own protocol. Luckily both my endos don't mind but I am kind of a special case with lots of fractures and several health conditions and sensitivities.

Anyway I recently read something interesting: that in the future short courses of Evenity might be used to build bone, between other meds. That is kind of what I had in mind.

Tymlos is not an anti-resorptive and builds quality bone. That is why I chose it. Evenity is both an anabolic (first half) and anti-resorptive (second half). My reasoning, not yet checked with doc, is that if I am going to do an anti-resorptive after Tymlos it might as well be Reclast, which "locks in gains." So I will stop Evenity and switch at some point. Yes this is unusual. Yes my doc has not prescribed this protocol as yet. This strategy is more appealing to me because I am having side effects with Evenity, and I will ask to switch to Reclast on that basis alone.

The science of all this is very complex and I am not trained to interpret studies, though I read them. I want to emphasize that everything I do is obviously sanctioned by docs, since they prescribe, and that I discuss things fully with them. In other words I am not a rogue patient but probably a difficult one!

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4 replies
susanfalcon52 | @susanfalcon52 | Mar 12 7:15am
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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triciaot,
Could you say more about why you’re choosing Reclast? I will be starting Reclast in May.

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1 reply
mayblin | @mayblin | Mar 12 9:17am
In reply to @windyshores "@rola your spine is slightly worse than hip, though the difference is probably not clinically significant...." + (show)
@windyshores

@rola your spine is slightly worse than hip, though the difference is probably not clinically significant. Tymlos is good for spine. You could do Tymlos for two years and by that time it may be more mainstream to do Evenity afterward. I had to convince my doc.

My idea was to do Evenity for just a few months, when it is a strong bone builder and before it becomes more of an anti-resorptive, so I wanted to do it after Tymlos, do a few months, then switch to Reclast. My doc told me I am creating my own protocol. Luckily both my endos don't mind but I am kind of a special case with lots of fractures and several health conditions and sensitivities.

Anyway I recently read something interesting: that in the future short courses of Evenity might be used to build bone, between other meds. That is kind of what I had in mind.

Tymlos is not an anti-resorptive and builds quality bone. That is why I chose it. Evenity is both an anabolic (first half) and anti-resorptive (second half). My reasoning, not yet checked with doc, is that if I am going to do an anti-resorptive after Tymlos it might as well be Reclast, which "locks in gains." So I will stop Evenity and switch at some point. Yes this is unusual. Yes my doc has not prescribed this protocol as yet. This strategy is more appealing to me because I am having side effects with Evenity, and I will ask to switch to Reclast on that basis alone.

The science of all this is very complex and I am not trained to interpret studies, though I read them. I want to emphasize that everything I do is obviously sanctioned by docs, since they prescribe, and that I discuss things fully with them. In other words I am not a rogue patient but probably a difficult one!

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windyshores if you see clinical trial results come out for short courses of evenity between other meds, please share. Thanks a lot!

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2 replies
Rubyslippers | @triciaot | Mar 12 9:57am
In reply to @susanfalcon52 "triciaot, Could you say more about why you’re choosing Reclast? I will be starting Reclast in..." + (show)
@susanfalcon52

triciaot,
Could you say more about why you’re choosing Reclast? I will be starting Reclast in May.

Jump to this post

Reclast was suggested by my endocrinologist. This was before I was diagnosed with BC. I’ve had osteopenia for years and avoided meds, but finally took Fosamax/alendronate after I moved to another city, dropped down into osteoporosis, changed my PCP doctor- and was convinced by her that I needed to see an endocrinologist about my bones. Fosamax (that first line med that insurance companies love) caused some minor stomach irritation, some diarrhea . . .and conjunctivitis, a lesser known side effect but evidently one that is important.
The endo then recommended the Reclast, we didn’t discuss bone builders. Maybe because my numbers were mostly still osteopenia with two areas in osteoporosis? Not sure. It seems a life time of decisions ago.
Before I could get the infusion scheduled, I was diagnosed with BC. I now have an MD Anderson rheumatologist following me. He agreed that Reclast was a good solution and would help protect my bones in case I have a cancer recurrence that is invasive and possibly metastatic.

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rola | @rola | Mar 12 9:59am
In reply to @windyshores "@rola your spine is slightly worse than hip, though the difference is probably not clinically significant...." + (show)
@windyshores

@rola your spine is slightly worse than hip, though the difference is probably not clinically significant. Tymlos is good for spine. You could do Tymlos for two years and by that time it may be more mainstream to do Evenity afterward. I had to convince my doc.

My idea was to do Evenity for just a few months, when it is a strong bone builder and before it becomes more of an anti-resorptive, so I wanted to do it after Tymlos, do a few months, then switch to Reclast. My doc told me I am creating my own protocol. Luckily both my endos don't mind but I am kind of a special case with lots of fractures and several health conditions and sensitivities.

Anyway I recently read something interesting: that in the future short courses of Evenity might be used to build bone, between other meds. That is kind of what I had in mind.

Tymlos is not an anti-resorptive and builds quality bone. That is why I chose it. Evenity is both an anabolic (first half) and anti-resorptive (second half). My reasoning, not yet checked with doc, is that if I am going to do an anti-resorptive after Tymlos it might as well be Reclast, which "locks in gains." So I will stop Evenity and switch at some point. Yes this is unusual. Yes my doc has not prescribed this protocol as yet. This strategy is more appealing to me because I am having side effects with Evenity, and I will ask to switch to Reclast on that basis alone.

The science of all this is very complex and I am not trained to interpret studies, though I read them. I want to emphasize that everything I do is obviously sanctioned by docs, since they prescribe, and that I discuss things fully with them. In other words I am not a rogue patient but probably a difficult one!

Jump to this post

@windyshores

Windy, thank you so much,! I have so much more faith in you than the Drs I've seen. So to be safe I'll do the tymlos, then hope we have more information to work with in 2 yrs. I appreciate you so much, it's all so involved. If it weren't for you and connect I'd be lost. I know I'll feel better finally just doing it.

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mlwh | @mlwh | Mar 12 10:05am
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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Usually it asks for the Femoral Neck

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ripley | @ripley | Mar 12 10:35am
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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Here's a link to the article I quoted, from 2015.
The drugs mentioned are bisphosphonates, Denosumab (Prolia) and strontium ranelate. https://www.bmj.com/bmj/section-pdf/897225?path=/bmj/350/8010/Analysis.full.pdf

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1 reply
njhornung | @normahorn | Mar 12 11:28am

There is also a movement questioning whether the treatments for cancer are being overdone. Would a slightly smaller dosage produce the same results but in a more tolerable manner.

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windyshores | @windyshores | Mar 12 3:37pm
In reply to @mayblin "windyshores if you see clinical trial results come out for short courses of evenity between other..." + (show)
@mayblin

windyshores if you see clinical trial results come out for short courses of evenity between other meds, please share. Thanks a lot!

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@mayblin it wasn't a study. It was speculation in an interesting article. If I find it I'll share it.

@rola those are nice words but I hope you find a doctor you trust. They know way way more than I do. I just post on my own experience and share resources!

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