1. < Osteoporosis & Bone Health

DEXA Scan Discrepancies: Spine improvement and hip worsened

Posted by anewyorker @anewyorker, Mar 3 8:47am

Good morning to all,

I just received my DEXA results from last week’s scan, and they were a classic good news, bad news story.

The good news is that my spine improved dramatically from a year ago, from a T score of -3.3 to -2.3. Distal radius was unchanged, femoral neck was marginally worse (-1.7 now vs. -1.3 last year).

The big change was in the hip—from -1.6 last year to -2.1.

I’ve had osteoporosis for 20 years. Recent treatment: I was on Prolia from 2020 through spring 2024, with little change in DEXA results. I stopped the Prolia and began taking Fosamax last April; the plan was to stay on that until January 2024, at which point I would switch insurance carriers to one that would cover Tymlos or Forteo.

Unfortunately, I developed very bad GERD problems and had to discontinue the Fosamax. So I was on nothing from October until January, when I began taking Tymlos. I’ve been lucky to be able to tolerate the full dosage from Day 1 with minimal side effects.

I’ve had one compression fracture, at L1, after a bad trip and fall last October. I’m doing PT to strengthen muscles ( I have a whole list of unrelated orthopedic problems that limit my mobility).

I’m 77, in quite good overall health.

So my question is whether anyone can help me understand why my spine improved so dramatically (did the Tymlos really make such a difference after only 7 weeks?) even as my hip worsened noticeably?

I should note that the two scans were done in the same place, so there shouldn’t be a huge discrepancy because no two machines give exactly the same result.

I’m sorry this is so long. All our situations are so complicated, aren’t they?

Thanks for your help.

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windyshores | @windyshores | Mar 13 2:44pm
In reply to @thisoldewe "Hi windyshores! Yes, all this quite correct for folks who do not have other autoimmune conditions...." + (show)
@thisoldewe

Hi windyshores!
Yes, all this quite correct for folks who do not have other autoimmune conditions.
My various lung problems cause some complications on the usual process.
I have gad a total of 3 Prolia shots. My infection rate increased one month after my first shot. To date, I have had 7 infections since commencing Prolua. Even with my severe asthma, bronchiatesis, and tracheobronchomalasia (sp), this rate of infection is too high, and is escalating.
Also, my osteoporosis seems due to high prednisone treatment, for the lungs and arthritis.
It is my Rheumatologist's recommendation to discontinue Prolia and go to Forteo.
The main concern is to get away from the bisphosphonates and their decrease in the immune system (mine has been in the basement most of my life) asthma starting at 2 years of age, and rheumatoid arthritis at 23.
So, in the midst of this pickle, the priority us protecting the lungs. (Pulmonary function drops with every infection)... and lungs are necessary for life! I have lost significant function since the Prolia, due to infections.
Bottom line, there is no perfect answer for this situation.
I do appreciate the soundness of your statements, for most people.
Thanks for replying.
I so appreciate all the support!

Jump to this post

I also have an autoimmune disorder. Can you share information on the effect of bisphosphonates on the immune system? I have not been told that. I have been told that Prolia affects the immune system and I have read that Evenity affects B cell production. My docs won't prescribe Prolia for me as a result. My doc would not prescribe Reclast during my cancer treatment due to afib, which is what got me in this mess with bones.

If you were on Prolia for that short a time, Forteo should be fine, according to those sources. In a way, it is fortunate that you are getting off! I am sorry for your experience. It makes me glad my doctors have spared me and I hope this next step is better for you!

REPLY
Christine | @thisoldewe | Mar 13 3:18pm

Thanks windy'
This is such a complex question: so many different aspects to consider.
Glad you have excellent docs. and seem to be making progress!
All the best to you!

REPLY
awfultruth | @awfultruth | Mar 14 10:49am
In reply to @thisoldewe "Hi windyshores! Yes, all this quite correct for folks who do not have other autoimmune conditions...." + (show)
@thisoldewe

Hi windyshores!
Yes, all this quite correct for folks who do not have other autoimmune conditions.
My various lung problems cause some complications on the usual process.
I have gad a total of 3 Prolia shots. My infection rate increased one month after my first shot. To date, I have had 7 infections since commencing Prolua. Even with my severe asthma, bronchiatesis, and tracheobronchomalasia (sp), this rate of infection is too high, and is escalating.
Also, my osteoporosis seems due to high prednisone treatment, for the lungs and arthritis.
It is my Rheumatologist's recommendation to discontinue Prolia and go to Forteo.
The main concern is to get away from the bisphosphonates and their decrease in the immune system (mine has been in the basement most of my life) asthma starting at 2 years of age, and rheumatoid arthritis at 23.
So, in the midst of this pickle, the priority us protecting the lungs. (Pulmonary function drops with every infection)... and lungs are necessary for life! I have lost significant function since the Prolia, due to infections.
Bottom line, there is no perfect answer for this situation.
I do appreciate the soundness of your statements, for most people.
Thanks for replying.
I so appreciate all the support!

Jump to this post

One distinction that may be important here is that Prolia is not a bisphosphonate. Therefore Prolia may have immune system consequences that bisphosphonates would not have. That may be of use in charting your course forward.

REPLY
1 reply
Christine | @thisoldewe | Mar 14 11:56am
In reply to @awfultruth "One distinction that may be important here is that Prolia is not a bisphosphonate. Therefore Prolia..." + (show)
@awfultruth

One distinction that may be important here is that Prolia is not a bisphosphonate. Therefore Prolia may have immune system consequences that bisphosphonates would not have. That may be of use in charting your course forward.

Jump to this post

Thanks for the correction on the classification.
Prolia does unfortunately, effect the immune system and does lower immunity, especially for those of us who are already having those difficulties... it seems to have been a poor initial choice with my history.
However, I am hopeful that the Forteo will cover all areas of need! A tall order!

REPLY
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