Accuracy of DEXA Scans

Femoral neck for the FRAX tool!

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/

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.

@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!

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

@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!

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?

@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.

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