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Dr sugggesting Prolia (Im 57, postmenopause 12 yrs)
Osteoporosis & Bone Health | Last Active: Sep 20 1:14pm | Replies (20)Comment receiving replies
Hello Mayblin,
I'm pasting my Dexa report because I'm not sure on some of your questions. I have had recent blood work done, below results.
Calcium 10.3
vitamin D-25-Hydroxy 74
I am only on 1 prescription and take a handful of supplements for gut, VitD, Omegas, Multi-Vit over 50.
Dexa Scan
COMPARISON: None available.
LUMBAR SPINE: L1-L4
- Bone mineral density (BMD) = 0.878 g/cm2.
- T-score = -2.6
- Change (%) since most recent prior (if available): None available.
FEMUR: NECK MEAN
- Bone mineral density (BMD) = 0.809 g/cm2.
- T-score = -1.6
- Change (%) since most recent prior (if available): None available.
IMPRESSION:
1. WHO Classification: OSTEOPOROSIS. Fracture Risk: HIGH.
FRAX generally not reported for patients with normal or osteoporotic BMD, in
patients younger than age 40 or older than age 90, in non-steroid-treated
patients younger than age 50, or in patients currently undergoing
pharmacotherapy.
TREATMENT RECOMMENDATION:
The Bone Health & Osteoporosis Foundation recommends consideration to initiate
pharmacologic treatment in postmenopausal women and men >= 50 years of age who
have the following:
- OSTEOPOROSIS: T-score < = -2.5 at the femoral neck, total hip, lumbar spine,
33% radius by DXA
- OSTEOPENIA / LOW BONE MASS: T-score between -1.0 and -2.5 at the femoral neck
or total hip by DXA with a 10-year hip fracture risk >= 3% or a 10-year major
osteoporosis-related fracture risk >= 20% (i.e., clinical vertebral, hip,
forearm, or proximal humerus) based on the US-adapted FRAX model.
NOTE: All decisions for treatment should be discussed between the patient and
one of their individual healthcare providers.
============================================================
WHO CLASSIFICATION:
The T-score compares the patient's BMD to the average BMD of a young adult. The
criteria below are from the World Health Organization:
- NORMAL: T-score -1.0 or above
- OSTEOPENIA / LOW BONE MASS: T-score -1.1 to < -2.5
- OSTEOPOROSIS: T-score -2.5 or lower
ISCD International Society for Clinical Densitometry's 2013 consensus
conference:
In Postmenopausal Women and in Men Age 50 and Older:
- T-scores are preferred.
- The WHO densitometric classification is applicable.
In Women prior to menopause and Men less than Age 50:
- Z-scores, not T-scores are preferred. This is particularly important in
children.
- A Z-score of -2.0 or lower is defined as 'below the expected range for age'
and a Z-score above -2.0 is 'within the expected range for age.'
- The WHO diagnostic criteria may be applied in women in the menopausal
transition.
- Osteoporosis cannot be diagnosed in men under age 50 on the basis of BMD
alone.
THANK YOU for any and all information. It's all new to me and I'm pretty good at researching but Osteoporosis is all over the place.
Replies to "Hello Mayblin, I'm pasting my Dexa report because I'm not sure on some of your questions...."
Thanks for sharing your results, kris1130! With a spine Tscore of -2.6 and femur neck at -1.6 (do you have total hip readings?), it doesn't seem like you're in a situation that requires rushing into medication just yet, unless there are other factors such as existing fractures, a high FRAX score, or cancer related reason (which doesn't sound like the case for you). This could be a good time to do lots of readings and work with your doctors to find out if any underlying causes might be contributing, and take a closer look at all your options. I found this table very useful - it gives a detailed list of secondary causes of osteoporosis, other than estrogen deficiency:
https://pmc.ncbi.nlm.nih.gov/articles/PMC5335887/table/t1-ejr-4-1-46/
My endo ran quite a few tests but didn't find any clear secondary cause. Still, I can see some of the factors on this list fit me, like low bmi and inconsistent calcium intake. I was also irregular with protein intake, which I think may have played a role. Oh, ask your doctor what s/he thinks about your calcium and vitd level.
You can run your numbers through the FRAX calculator using this link:
https://www.fraxplus.org/calculation-tool
If your Dexa includes TBS, then your FRAX score can be further adjusted by built-in calculation.
The first medication choice really matters, since it sets the stage for what comes next - typically, starting with an anabolic is preferred. The challenge then becomes how to maintain those gains over long term, or whether to consider using an anabolic again further down the line. Sequencing of two-drug regimen has been studied more, but evidence is limited for more complex or longer sequences. HRT could be a good option to consider at your age, depending on how the risks and benefits line up for you. There is a good thread where many members discussed the safety of HRT:
https://connect.mayoclinic.org/discussion/hrt-safety/
There are also many youtube videos on HRT use by obgyns.
Everything will come together as you gather this information and feel well prepared discussing your options with your doctor. Wishing you the best. Please keep us updated on how things go!
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First of all, I would say that your Tscores,
compared to most people who NEED to get on osteoporosis medications, are excellent. Your -2.6 Tscore is on the edge of osteopenia. I didn’t see your FRAX score. I would take into account what your FRAX score is before starting medication . I remember seeing somewhere (maybe the NIH) that medication is not required as long as your FRAX rate is below 20%, you have not fractured, and you are in the osteopenia range.
I hope this helps. Educate yourself before starting the meds. If you decide to start taking them, make sure your doctor knows to test your CTX and P1NP (bone turnover markers) before starting the meds, then repeating those tests every 3-4 months to make sure the meds are doing what they are supposed to be doing! If your doctor doesn’t know what I am talking about, look for another one.
Here is the link to calculate your FRAX score;
https://www.fraxplus.org/calculation-tool
It is never too late to start eating better and do more exercises, especially while you decide which path to take. Listen to some podcasts by Margie Bissinger, Dr Doug Lucas and Sarah Mapes about osteoporosis. They have helped me to be more educated and NOT so scared about the diagnosis, especially if you are a healthy person (other than the OP)!!
Also, don’t BEND over to pick up things or touch your toes anymore! Make sure you hip hinge! Watch videos from people I mentioned above on proper lift techniques, how to exercise, etc.