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.

windyshores | @windyshores | Mar 13 11:21am
In reply to @awfultruth "Mayblin here is a clinical trial that is looking at shorter courses of Evenity. It appears..." + (show)
@awfultruth

Mayblin here is a clinical trial that is looking at shorter courses of Evenity. It appears to have started in late 2023. The results won't be in until 2026 unfortunately (if it stays on schedule).

"The study will investigate if it is possible to maximize the effect of romosozumab by giving it in 2 periods of 6 months interrupted by zoledronate for 12 months compared to romosozumab for 12 months uninterrupted followed by zoledronate for 12 months. The investigators will also evaluate if 6 months of romosozumab followed by 18 months of zoledronate is non-inferior to the standard regimen of romosozumab for 12 months followed by zoledronate for 12 months."

Links (both are about the same study):
https://ctv.veeva.com/study/the-optimised-use-of-romozosumab-study
https://classic.clinicaltrials.gov/ct2/show/NCT06059222

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@awfultruth looks like I am doing a 6 months Evenity, 12 months Reclast, 6 months either Reclast or Evenity trial myself!! Or maybe even shorter time on Evenity. I wish I was in the study! Thanks. I will copy this for my doc.

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1 reply
rola | @rola | Mar 13 11:48am
In reply to @rjd "Is that the amount for which the Clinic billed your insurance? Or it that the amount..." + (show)
@rjd

Is that the amount for which the Clinic billed your insurance? Or it that the amount that the insurance paid? The difference is often breath-taking but the Explanation of Benefits should give you this info.

And if you are on Medicare, you likely had no co-pay, is that correct? If not, what was your co-pay on Medicare, and if not on Medicare, how much was out of your pocket for this procedure?

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That is the amount billed to insurance. Hopefully it will be paid in full, since I had one last year. I needed to see this before deciding on treatment.

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njhornung | @normahorn | Mar 13 12:05pm
In reply to @rola "(@normahorn) I'm at the exact same place as you Norma. I had 2 scans, one in..." + (show)
@rola

(@normahorn)

I'm at the exact same place as you Norma. I had 2 scans, one in Dec 2022 without TBS VFA(Vertebral Fracture Assessment) & my most recent, Feb of 24, with TBS/VFA.
Second scan performed in a different facility. It's, in my mind, not that I doubt there's a system in place that qualifies the need, but is that system accurate? The list of variables is endless and not cemented unless you've already fractured! Variables such as in machines, positions, technicians, health history, contridicting studies, new data, on and on! I keep reading, watching videos & there's not enough time in the day. Sooner or later it affects your well-being & you need to decide. I've vacillated for over a year. I see my Rheum in April and will make that decision then. Stressed since diagnosis 2022!

Information chgs in time, I get it, but I think the *summary below is still worth noting (could not access articles) and the *article on the stats gathered for use of meds according to "their" research. It is, no doubt, what we ourselves feel most at peace with. Yet, one thing for sure, "Harms from overdiagnosis—Being labelled as at risk of fracture imposes a psychological burden.!" Since we live longer are these the necessary tools, if all else failed, and at the same time I read hip fractures in Finland have leveled off, why? What I am positive about, is mindfulness, practice to incorporate the whole body approach to this dilema.

Osteoporosis: How effective are the medications used to prevent bone fractures? - InformedHealth.org - NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK532851/
https://www.bmj.com/content/350/bmj.h2088
https://www.sciencedirect.com/science/article/abs/pii/S0167494318300694
Recent DXA VFA, you'll have to click to enlarge and swipe to right for added rept.

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You later asked for our impressions on your recent scans. Not familiar with TBS to comment.

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mayblin | @mayblin | Mar 13 2:42pm
In reply to @awfultruth "Mayblin here is a clinical trial that is looking at shorter courses of Evenity. It appears..." + (show)
@awfultruth

Mayblin here is a clinical trial that is looking at shorter courses of Evenity. It appears to have started in late 2023. The results won't be in until 2026 unfortunately (if it stays on schedule).

"The study will investigate if it is possible to maximize the effect of romosozumab by giving it in 2 periods of 6 months interrupted by zoledronate for 12 months compared to romosozumab for 12 months uninterrupted followed by zoledronate for 12 months. The investigators will also evaluate if 6 months of romosozumab followed by 18 months of zoledronate is non-inferior to the standard regimen of romosozumab for 12 months followed by zoledronate for 12 months."

Links (both are about the same study):
https://ctv.veeva.com/study/the-optimised-use-of-romozosumab-study
https://classic.clinicaltrials.gov/ct2/show/NCT06059222

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@awfultruth thank you so much for this powerful search result! Can't wait till the results come out. I'm curious about the zolendronate choice. In theory zolendronate is the strongest and longest acting of all bisphosphonates, how would it affect osteoanabolic effect? In theory it would dampen. Would a lower dosing or shortened treatment period (with lower dose) be better? Note that the study includes only patients with prior fracture within 3 years. Also, one of the labs for this study is ogtt. Does this imply glucose metabolism would be affected by the meds or would an imparied glucose metabolism influence the results?

Does anyone know how long does zolendronate stays in the body, or it's terminal half life?

How do you get this search results (for a clinical trial that's on going)? If you come across any on going clinical trials for extended treatment for forteo beyond 2 years or cyclic treatment with forteo, please share. I'm ready to volunteer.

Thanks a lot!

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mayblin | @mayblin | Mar 13 2:49pm
In reply to @windyshores "@awfultruth looks like I am doing a 6 months Evenity, 12 months Reclast, 6 months either..." + (show)
@windyshores

@awfultruth looks like I am doing a 6 months Evenity, 12 months Reclast, 6 months either Reclast or Evenity trial myself!! Or maybe even shorter time on Evenity. I wish I was in the study! Thanks. I will copy this for my doc.

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windyshore, are you saying you'd be doing 6mo evenity, then 12mo reclast, then 6 mo evenity (or reclast)? If so, your plan is pretty lose to the trial 🙂

Please tell us you will be doing dexa right after finishing this round of evenity, to see the effect of tymlos+evenity

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2 replies
mayblin | @mayblin | Mar 13 2:51pm
In reply to @mayblin "windyshore, are you saying you'd be doing 6mo evenity, then 12mo reclast, then 6 mo evenity..." + (show)
@mayblin

windyshore, are you saying you'd be doing 6mo evenity, then 12mo reclast, then 6 mo evenity (or reclast)? If so, your plan is pretty lose to the trial 🙂

Please tell us you will be doing dexa right after finishing this round of evenity, to see the effect of tymlos+evenity

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Correction: close not lose to the trial 🙂

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njhornung | @normahorn | Mar 13 3:34pm

I found this of concern as it may disqualify me. It is a question I have in general about Evenity. Would it affect the stage of my cll?

Exclusion Criteria:
Metabolic bone disease

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windyshores | @windyshores | Mar 13 11:03pm
In reply to @mayblin "windyshore, are you saying you'd be doing 6mo evenity, then 12mo reclast, then 6 mo evenity..." + (show)
@mayblin

windyshore, are you saying you'd be doing 6mo evenity, then 12mo reclast, then 6 mo evenity (or reclast)? If so, your plan is pretty lose to the trial 🙂

Please tell us you will be doing dexa right after finishing this round of evenity, to see the effect of tymlos+evenity

Jump to this post

@mayblin I see my endo next week and was going to ask for a DEXA. I also did a second round of CTX and P1NP. The CTX is low but the P1NP was disappointingly low at the 30 day point for the first month of Evenity. Doc said to test mid-month so I just did that. Will share.

My original idea was to do 3-6 months Evenity, whatever I could tolerate, and then since it becomes anti-resorptive in the second half , switch to Reclast to finally lock in gains from Tymlos and Evenity. We'll see!

I really appreciated seeing that study. Made me feel less like an outlaw 🙂

I am so sensitive to meds and it took me so long to tolerate anything (I am tolerant of side effects so I truly could not tolerate most options) that I think my docs are grateful for anything I manage to take!

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worley725 | @worley725 | Mar 14 8:27am

I think things need to be discussed with the doctor regarding certain tests being done. More than one test needs to be looked into regarding diagnosis and treatment. As additional blood work.

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andreamayo | @andreamayo | Mar 14 1:30pm
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 was $900?

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