Accuracy of DEXA Scans

I trust that McCormick is using the term "clients' rather than "patients" when it comes to osteoporosis. Otherwise he might be crossing the line into practicing medicine without a license. When it comes to chiropractic, the term "patients' would be appropriate.

@normahorn McCormick is a chiropractor so is "patients" appropriate?

@baguette this kind of detail in evaluating DEXA's was valuable for you. For some of us, the error rate isn't as important as the overall picture. In other words, for scores below, say, -3.5, I don't think error matters. I have been told that changes plus or minus -.5 are clinically significant, and my report also says not to use the femur neck score to evaluate changes. I have kept a chart of my DEXA's since 2001 and I look at trends rather than specific values. For me, considering issues with DEXA accuracy did not argue against meds!

(@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.

I think we would all want the DXA test to be very accurate with no complicating factors, at least before we've had the test. Once we've had the test and if we have a bad score we want complicating factors to explain away that bad score so that we can have some hope that we really don't have that bone loss or that maybe it isn't as bad as it seems. At least it was that way for myself.
I paid to have Lani Simpson review my scans because I had lost so much bone between 2 of the scans. Unfortunately she said the scans were good and my bone density was dropping rapidly. At least I knew for sure or as close to sure as I was going to get that I was declining in bone density and that my efforts so far have not stopped that. Note: I have had 5 scans over the past 4 years and the last 4 were on the same machine and with the same technician so I've got a pretty clear view of how I'm doing DXA wise.

My bone density has declined to a worst of -4.1 t-score in the spine at my most recent scan. I have not fractured unless there are silent thoracic fractures. I wish DXA scans were better with no inconsistencies or worries about accuracy. I wish all the factors were known about how bone density and bone quality and bone strength and bone mass and yet unknown factors effected the risk of fracturing. BTW my TBS score is also bad. Not sure which TBS numbers are most relevant but I ranged from L1 0.984 to L4 at 1.305. My TBS scores did actually improve slightly. Still no fractures and plenty of opportunity for them. It is all frustratingly imperfect.
Still so glad I haven't fractured.

I think we have to be aware of the imperfections in all this and analyze the tests value and accuracy as best we can. And of course get the best help we can to help us sort this out. Despite the issues surrounding DXA scans I see them as very useful and not to be ignored. It's a test that provides useful information. Unfortunately many, maybe most docs do not know how to make best use of that information. It is up to each of us to try to do that. No matter what all the other factors are rapidly decreasing bone density or a very low steady state bone density are not good.

Despite doing the full set of blood tests that Lani recommended I/we could find no underlying explanation for my high rate of decline in density. A decline I could not stop despite dietary changes and following good resistance training and other exercise protocols. I chose to take Evenity and have had 5 shots so far. Fingers crossed. I'm still working on the dietary and exercise angles more than ever but I'm hoping this med makes a big difference.

@awfultruth I was starting to second guess starting Evenity. I am a short small-boned Asian woman. The T-score in my spine was -4. I haven’t had any recent bone fractures. My grandma was diagnosed with osteoporosis and had a compression fracture in her spine from lifting something heavy.

@shorty321 Hi, I see you are responding to a comment I made maybe two years ago. Are you asking a question? I see you have been asking questions about long term treatment which is a puzzle for us all. At this point I'm wondering if an answer for some might be short repeat rounds of an anabolic like Evenity or the other anabolics interspersed with mostly short rounds of bisphosphonates with long gaps after each cycle as permitted by following bone markers.
What I'm curious about might resemble 3 months Evenity, 6 months of Fosamax or Risedronate and then continue following bone markers monthly or every two months to see if you can reach a steady state. My hope would be that I could reach points where I could go years after the bisphosphonate before doing the next round. All theoretical at this point.

I realize that requires a lot of effort and thought on the individuals part. I don't think we can expect the doctors or drug companies to investigate this type of strategy. It probably does not fit with how they practice (the doctors) or how they market meds (the drug companies) but I think it may be what would fit for those of us with osteoporosis who are willing to shoulder the effort.

And of course doing everything else one can to help our bones as in exercise, nutrition, hormones, sleep and so on.