Hello, I joined today to get help in deciding what medication to begin

Sorry, that’s 18 months of tymlos Followed by recklast

My doctor wants me to take Prolia but I haven’t seen it mentioned in the discussions so far. I took Fosamax until my esophagus and stomach revolted after 10 years. I have been off for well over a decade and am hesitant to try again. Is there a natural way?

Do you mean that you took Fosamax for 10 years?

I had no bad issues at all with Prolia and numbers got better. I went from osteoporosis to osteopenia. But when you get off after a few years, you need to follow it with something like Reclast to preserve your gains.

I don’t know what you should but I am at the crossroad too. I took it for about 20 years with a few years off. I have major bone loss now in my jaw. And the specialist say dental ask me why I am not on a bone building medication. Still waiting on an appointment with a specialist. It’s a bit overwhelming.

@windyshore

We've been waiting for the x-ray results of my husband's spine. They came in today and I haven't yet spoken to his doctor. I read over them quickly (busy working so didn't have a lot of time) and it is all very confusing. Not sure what all this means. I would love your thoughts if you have time to look this over.

IMPRESSION:
1. Given differences in technique, mildly 11 anterior wedge compression deformity with no retropulsion, or progression.
2. New superior endplate compression deformity of L1 vertebral body measuring approximate 25% with no retropulsion. New/newly recognized superior endplate Schmorl's node versus central superior endplate compression deformity of L3 vertebral body. No retropulsion.
3. Degenerative changes of the thoracolumbar spine as described above.
4. Ancillary findings as described above.

EXAM: XR LUMBOSACRAL SPINE AP AND LAT, XR THORACIC SPINE 3 VIEWS
EXAM DATE AND TIME: 6/17/2024 7:40 AM

HISTORY: CLINICAL CONCERN: new low back pain, eval compression fracture (differential diagnosis or r/o)

COMPARISON: CT of the neck, chest and abdomen 3/5/2024.

TECHNIQUE: AP, lateral and swimmer's views of the thoracic spine. AP and lateral views of the lumbar spine.

FINDINGS:
Thoracic spine:
The visualized thoracic spine demonstrates normal alignment without significant curvature. Given differences in technique, stable anterior wedge compression deformity of T11 vertebral body. New superior endplate compression deformity of L1 vertebral body. No retropulsion. Osteopenia. No listhesis. Mild diffuse degenerative disc disease of the mid thoracic spine.

Visible regional adjacent bones and soft tissues of the medial chest and upper abdomen are otherwise unremarkable.

Lumbar spine:
Dextroscoliosis of the thoracolumbar junction. New superior endplate compression deformity of L1 vertebral body measuring approximately 25%. No retropulsion. Superior endplate Schmorl's node versus compression deformity of the central 7. Endplate L3. No retropulsion. Moderate diffuse degenerative disc disease L2-3 through L5-S1. Subtle grade 1 anterolisthesis of L3 on L4. No pars defects.

Mild osteopenia.

Soft tissues unremarkable.

His doctor will go over this. I am not trained.
It looks like the T11 fracture is mild and stable.
L1 fracture is 25%, not bad in my experience.
L3 looks more complicated (see definitions if you follow links below).
Posture is still good so curvature of spine is not apparent- that's good!
https://www.healthline.com/health/schmorl-nodes#fa-qs
https://www.spineinfo.com/conditions/anterolisthesis-definition-causes-symptoms-prevalence-diagnosis-and-treatments/
The imaging has certainly found reasons for low back pain I would think. I hope he has a doctor he trusts. Sometimes an orthopedist who does not do surgery can be helpful (again in my experience).

He has osteopenia so why is he fracturing? That seems to be a big question that may guide treatment.

@windyshores

Thank you for your reply. I appreciate your time to review and give your thoughts on his results. I've got an email to his endocrinologist and waiting to hear back. He also has an appointment with a physical therapist on Friday (virtual appt) to discuss test results and to determine if he's knowledgeable enough about osteoporosis to make an in-person appointment. I asked about an orthopedic surgeon and our GP said no, but I didn't ask for an orthopedist who doesn't do surgery. I can try that.

That's good to hear your thoughts that the L1 fracture at 25% might not be bad - it had me worried as I believe it's new. Thank you for the links. I will check them out.

I thought it was interesting that it noted osteopenia when he's been diagnosed with osteoporosis (lumbar spine at -3.3.) I've included his scores from the bone scan below.

Bone scan results:

Tallest height patient has ever been (patient reported): 71 in
Current height: 69.5 in

Risk factors entering to the FRAX in this patient:
Glucocorticoids (Chronic)

10 YEAR FRACTURE PROBABILITY
Based on FRAX (R) TOOL- https://www.sheffield.ac.uk/FRAX/tool.aspx?country=9

Major osteoporotic fracture: 11.6%
Hip fracture: 4.2%

LUMBAR SPINE
Bone Mineral Density: 0.81 g/cm2
LUMBAR SPINE T-SCORE: -3.30
Z-score: -2.80

LEFT TOTAL HIP
Bone Mineral Density: 0.79 g/cm2
LEFT TOTAL HIP T-SCORE: -2.10
Z-score: -1.30

RIGHT TOTAL HIP
Bone Mineral Density: 0.73 g/cm2
RIGHT TOTAL HIP T-SCORE: -2.60
Z-score: -1.70

LEFT FEMORAL NECK
Bone Mineral Density: 0.87 g/cm2
LEFT FEMORAL NECK T-SCORE: -1.50
Z-score: -0.20

RIGHT FEMORAL NECK
Bone Mineral Density: 0.83 g/cm2
RIGHT FEMORAL NECK T-SCORE: -1.80
Z-score: -0.50

Isabelle,
DXA can't determine fracture. It only determines weak bone and possibility of fracture. While X-Ray delineates fracture, but can't determine osteoporosis. (although dxa is technically x-ray) Nice that they collaborated with CT. CT can sometimes detect hairline fractures not detected by X-Ray or even MRI which I'd prefer to the X-Ray, as more sensitive especially to current fracturing than X- Ray.
I'd be curious about the T-score at L-3 which may be measuring the smorls node and would be a lower score. And shouldn't be included in the total lumbar number -3.3 And maybe it isn't.
Smorls nodes are areas where the disc has displaced bone either because of a herniated disc or birth presence. Herniated discs can be painful. The nucleus of the disc is able to penetrate the bone because it is very acidic. Breeching the endplate with fracture or smorls makes the vertebra more vulnerable to further compression.
His spine has good alignment wherever you see not lithesis or retropulsion. Which is almost everywhere. There is a "subtle anterolithesis" of L3 on L4 (L3 is sliding slightly forward over L4). No pars is cited so that you know there is no fracture at the appendage on the back of the vertebra which can cause a vertebra to slide forward.
After a short period of concentration the terminology sets up an unnerving vibration in the ear. I'm thinking that this is enough. If you want more torture, I[m on call, even though I've no training.

@gently

Thank you for your response. You said you'd be curious about the T-score at L-3. The only T scores I saw on the results were what I've posted above (lumbar, hip, neck).

I'm just learning about the Smorls nodes. I've never heard of them before. As I've never heard of many other words and phrases in these results. This is the first time we've had to deal with anything to do with the spine.

It's good to hear his spine has good alignment. We felt pretty lousy the other day when his rheumatologist reviewed his most recent x-rays and said "You have a 75-year old back. Looking at the x-ray you have a bad back." She kept stressing he has a "bad back" which left him feeling more like he was 100 rather than 75. In her defense, she did say she wasn't very knowledgeable when it comes to reading x-ray results (this was before we had the tech's impression.)

You are right that this is all pretty torturous. LOL Though I feel it's important that I learn as much as I can because I'm not thrilled with the treatment he's gotten so far, or lack of treatment in some cases. It feels like most of the doctors, even specialists, are not really on top of their game. His first rheumatologist could literally have cost him his life when she refused to believe he had Giant Cell Arteritis. I had to push for a biopsy which showed he did have it. I knew he did from all the symptoms he had. His was textbook. And it turned out the same rheumatologist didn't even know the proper way to treat him which created huge issues (we finally were able to switch and have a better one now, so we hope). It was an ER doctor who told us he wasn't being treated properly for his condition and put him on high doses of IV infusions (prednisolone). He's been on high-dose prednisone for over a year which is what is causing his bone issues.