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If newly diagnosed with osteopenia or osteoporosis of spine
The first thing needed, to my way of thinking: x-ray of the spine
Why: DXA is limited. If the vertebra has had a compression fracture - which can occur without any pain (you can have one without knowing) - the t-score will be erroneous. The nature of a compression fracture is to make the bone appear denser. So the t-score will appear better than the one previously taken, before the fracture.
To my way of thinking, it's ridiculous to follow spine t-scores without knowing the full reasons behind the values. Baseline information about the vertebrae is a must. I don't understand why it's not standard protocol to x-ray the spine when osteopenia/porosis is diagnosed.
And, for every succeeding DXA, the information about compressed fractures is essential - operators are not supposed to include affected vertebrae in the calculation. Operators are also only to report the spine t-score if at least 2 vertebrae can be measured.
My cynical self is coming up with bad reasons why x-rays aren't part of the initial write-up. It's easy to throw medicine at a t-score. DXA salespeople aren't motivated to talk about machine limitations. If a t-score is low enough, insurers can refuse to pay for certain types of prescriptions and procedures.
I've had osteopenia of the spine, and now osteoporosis, on record since a DXA in 2020. In that time: three primary care docs and three endocrinologists - and none sought x-rays. Have I been seeing all the wrong people??
Only this week did I have x-rays done, and ugh, there were compression fractures, bone spurs and an inflammatory spinal arthritis. No, I had no idea. Only very mild back aches over the years that I attributed to growing older and less active. I did let my drs know about the aches.
If I could go back in time 6 years, I'd push for x-rays.
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You make some good points…DEXA JS just 1 tool…we need to know more about spine issues, in order to come up with the best plan.
"The nature of a compression fracture is to make the bone appear denser. So the t-score will appear better than the one previously taken, before the fracture." If that's the case, and your DEXA shows osteoporosis, then your "true" bone density is actually *worse* than what appears on the report. Also... DEXA gives you bone density in your hips, which is obviously important.
An X-ray basically shows you what happened, not necessarily why it happened. Let's say you had an X-ray years ago and it showed a history of compression fractures. OK, what next? Maybe you need an MRI to diagnose any disc problems. if you have aches. Maybe you need a DEXA to check bone density. An X-ray alone isn't going to cut it.
I totally agree with you that any one test is not sufficient! The more information we have, the better. If you go to the orthopedist complaining of back issues, then an X-ray is often one of the first things they do, followed by an MRI if necessary.
The doctor also matters. I am male. I had a compression fracture not from a fall. The orthopedist did an X-ray and MRI. He did not once mention osteoporosis, probably because I'm not female. My PCP suggested a DEXA which showed a T-score of -3.4. Otherwise, I would not have known.
So tired of bones... 🙂 🙂
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3 ReactionsThank you @nycmusic and @njx58!
If I implied an x-ray was sufficient, I'm sorry! Didn't mean to. I think it's a necessary first step in ascertaining how the t-score of the spine was derived. What you describe about the orthopedist not thinking to order a DXA . . . makes me shake my head. It would seem to be a logical test for anyone with a compression fracture.
More evidence of the need to be advocates of our care . . . and have doctors who are willing to listen and think logically.
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3 ReactionsI think the reason DEXA's are used to diagnose and follow osteoporosis, and not routine X-rays, is to prevent unnecessary radiation exposure. DEXA's result in less radiation. A DEXA scan exposes you to about 0.001 to 0.035 mSv of radiation, while a standard X-ray typically ranges from 0.1 mSv for a chest X-ray to 1.5 mSv for a lumbar spine X-ray.
If you want spine X-rays, you can ask your doctor about it. I requested x-rays when I suddenly woke up with bad lower back pain. I was worried I might have a fracture. The x-rays didn't show any fractures, but verified my severe osteoporosis and also osteoarthritis. I've since read that not all fractures show up on x-rays, but would need an MRI to show them.
Also from what I've read, vertebral compression fractures do not make bones appear denser on DEXA scans.
This article might be helpful: https://www.vintechmagazine.com/x-ray-vs-dexa-scan-unveiling-the-pros-and-cons-of-each/
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1 Reaction@karyn23 I have told my adult kids this joke many times: You know what they call the person who graduated at the bottom of the class in medical school? "Doctor."
Just because there's a degree hanging in a frame on the office wall doesn't mean he/she is competent.
I'm not sure there is any condition that has more misinformation and medical incompetence than osteoporosis. We really do have to be our own advocates.
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5 ReactionsYou can see discussions of REMS scans as adjunct to DEXA elsewhere in this forum.
Here is just one reference.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11988531/
EXCERPT: ". Conclusions
In conclusion, REMS technology effectively identifies cases of osteoporosis and osteopenia, representing a significant advance in detecting and monitoring osteoporosis. This technology ... does not use ionising radiation ..."
@kfhoz Thank you for this! Much appreciated.
@daisy17 Thank you so much for this info. I so appreciate it. So much to learn and digest. The research I've seen says that compression fractures do make the bones appear denser on DXA - perhaps there have been advances in the machines to account for fractures. I hope so. I'd love to pick the brains of a couple radiologists . . .
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2 Reactions@karyn23 Well, that sounds interesting so I did another search on-line. AI Assist says this: "Compression fractures can make bones appear denser on DXA scans because the collapsed vertebrae may show increased mineral content in the affected area, leading to a misleadingly higher bone density reading. This is why additional imaging, like vertebral fracture assessment (VFA), is often used alongside DXA to accurately assess bone health and fracture risk."
I also found this article which is extremely interesting, titled "Correlation Between Bone Density and Lumbar Compression Fractures:: https://journals.sagepub.com/doi/full/10.1177/2333721420914771