1. < Osteoporosis & Bone Health

New to this journey and would like advice where to start.

Posted by naninct @naninct, Oct 14 3:38pm

Hi all. As a new member, this is my first post. I am a 67-year-old female, 145 lbs, 5’5” and fairly active. I work in my yard and walk for exercise. I found out last Monday, October 7, 2024, that I have osteoporosis in my lumbar spine. I have a prior DEXA score from 2021. Here are the 2 results:

2021 DEXA scan showed L1-L4 at 0.825 g/cm² with a T-score of -2.0 (osteopenia), but in 2024 it dropped to 0.772 g/cm² and a T-score of -2.5 (osteoporosis). My hips were osteopenic both years: left neck (0.776 to 0.731 g/cm², T-score -0.7 to -1.1), right neck (0.789 to 0.741 g/cm², T-score -0.5 to -1.0), and total left/right (T-scores from -0.4 to -0.9).

In September 2024, it was painful for me to sit at my desk chair. I eventually bought a cushion to keep the pressure off of my tailbone because that is where I was feeling the pain. Coincidentally, I had a DEXA scan scheduled in the last week of September so I asked my PCP what I should do about the pain in my coccyx area. She said let’s take x-rays at the same time. This the result of my x-rays:

Impression
Possible coccygeal fracture and/or traumatic listhesis. X-rays provided limited specificity. The sacrum is intact.
Narrative
AP and lateral views of the sacrum/coccyx. No comparison studies. Slight AP offset on lateral view between the upper coccyx and each of the lower 3 coccygeal segments. This is a nonspecific appearance and could be developmental or posttraumatic. The next to last coccygeal segment (presumably C4) appears hypodense compared to the others. This could represent a fracture, or superimposed soft tissue lucency. The sacrum appears normal. SI joints are normal.

Thinking that I may have a possible fracture of my coccyx bone, I made an appointment with a orthopedic doctor and saw a PA on Thursday, October 10, 2024. He said in the 20 years of his career, a coccyx fracture was never the result of osteoporosis. I asked the PA who I should see for osteoporosis and he said Northeastern Connecticut is lacking in support for osteoporosis. He said there is a center at UConn in Farmington.
After reading some of the posts here when I joined last week, I bought "Great Bones" by R. Keith McCormick. I am diving into that right now.
I do have Hypothyroidism and take a supplement for that. I do not take any prescription medications and I see a Naturopath every 6 months.
I don’t even know where to start. Can anyone give me any advice? Thank you!

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newenglandtransplant | @newenglandtransplant | Oct 14 5:00pm

Hi, @naninct. I’m also in CT. Dr. Faryal Mirza at UConn was recommended to me by an endocrinologist in Chicago. Your doc will need to send a referral. When I called in July, she was booking out to February. There is also Dr. Clemens Bergwitz at Yale New Haven, which will require a referral from a PCP in the Yale network. When I called in July, he was booking out to January.

I didn’t have the patience / mental fortitude to wait 6 months for an initial endocrinology consult, so I headed to Mayo with the thinking I can also transfer care closer to home at some point.

Also, if you haven’t found this video by Michael Lavacot yet, it is a great place to start.

REPLY
windyshores | @windyshores | Oct 14 5:05pm

Your bones aren't bad according to those scores. You have a -2.5 but DEXA's vary and the margin of error means you could be below or above that number. It is a spectrum, not a point in time, so going from -2.4 to -2.5 isn't that significant. You might want to consult with Keith McCormick in person or by phone if you like his book.

The last time I had bone scores like that was 20 years ago! It seems as if you are in a range where holistic approaches might be helpful, But yes discuss with naturopath, endocrinologist, and maybe McCormick.

To my knowledge and in my experience, osteoporosis does not cause pain. That actually makes it more dangerous in some ways. It seems as if the coccyx pain is a separate issue from your bone density, as your orthopedist implied. It would help to know if it is a fracture or something congenital or what.....I hope you can have an MRI to clear that up.

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windyshores | @windyshores | Oct 14 10:43pm
In reply to @windyshores "Your bones aren't bad according to those scores. You have a -2.5 but DEXA's vary and..." + (show)
@windyshores

Your bones aren't bad according to those scores. You have a -2.5 but DEXA's vary and the margin of error means you could be below or above that number. It is a spectrum, not a point in time, so going from -2.4 to -2.5 isn't that significant. You might want to consult with Keith McCormick in person or by phone if you like his book.

The last time I had bone scores like that was 20 years ago! It seems as if you are in a range where holistic approaches might be helpful, But yes discuss with naturopath, endocrinologist, and maybe McCormick.

To my knowledge and in my experience, osteoporosis does not cause pain. That actually makes it more dangerous in some ways. It seems as if the coccyx pain is a separate issue from your bone density, as your orthopedist implied. It would help to know if it is a fracture or something congenital or what.....I hope you can have an MRI to clear that up.

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Just want to add that DEXA scores don't tell the whole story (TBS measuring bone quality can add more info) and people with osteopenia or mild osteoporosis do fracture. The presence of a fracture would indicate a need for medication, unless you had some sort of trauma . So the question of whether there is fracture is important. At the same time, your doctor said that osteoporosis causing a fracture in the coccyx is very unlikely. Again, an MRI will clarify I hope.

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