Hip/spine osteopenia: forearm osteoporosis

I had heard that forearms, because they are smaller bones, often show inflated DEXA scores vs other bones in the body. For me, my worst score was in my forearms.

This article says "DXA can make a small-boned person look more osteoporotic than they truly are, and it can make a larger-boned person look more protected than they really are. This limitation is especially relevant when the forearm is measured. ISCD recommends forearm BMD primarily when the hip or spine cannot be measured or interpreted, in hyperparathyroidism, or when a patient exceeds the weight limit of the DXA table. That caution is important. Because forearm DXA is still based on areal density, it can be especially vulnerable to bone-size effects. In a smaller-framed patient, the forearm may look disproportionately low. In a larger-framed patient, it may look somewhat more reassuring than the true skeletal picture warrants."
https://www.osteoboost.com/blog/bone-scans-dxa-rems-qct-tbs-bone-turnover-markers
So, your hip and spine DEXA scores are more important than your forearms. It sounds like your scores there are in the osteopenia range. If that's the case, I personally would not take any bone meds if only my forearms showed osteoporosis.

In regard to Reclast, that is a bisphosphonate medication. After reading about the severe side effects some people have experienced with it, if I were going to take a bisphosphonate, I would take an oral form first and see how I reacted to it. But, in the long rung, studies show that bisphosphonates don't offer much benefit in preventing fractures. They retain old bone and slow growth of new bone, so maybe the BMD you are gaining is not strong? Here are a couple of articles on bisphosphonates that might be of interest to you.
https://www.amjmed.com/article/S0002-9343(24)00101-3/fulltext
https://www.consumerreports.org/cro/2012/04/popular-osteoporosis-drugs-come-with-mounting-concerns/index.htm
Bones change very slowly, so take time to research so you are comfortable with your decision if you decide to take a bone medication. In the meantime, check out Brick House Bones in Facebook by Dr Lisa Moore, a PT specializing in osteoporosis. She has free exercise videos and information, although drugs are not discussed. The Better Bones website also has great information.

Thank you so much for taking the time to post this comprehensive response to me!! You validated everything I am thinking. Especially because I was tested for parathyroid disease and did the long haul urine test. I was even tested for myeloma. All negative.

I really appreciate your response!!

Hello @maloc,

As you have likely encountered here on Connect, osteoporosis comes in many forms, effected areas and, severity and varying fracture risks for each member who has been diagnosed. It is important to remember that Connect is a place for sharing experiences to have more informed conversations with our providers. Choosing which treatment or to forego treatment is a decision that should not be made lightly but should include your provider. It may also be worth getting a second opinion before starting an osteoporosis medication if you are not comfortable with the course of treatment.

You may also find this article helpful:

"Osteoporosis treatment: Medications can help"
- https://www.mayoclinic.org/diseases-conditions/osteoporosis/in-depth/osteoporosis-treatment/art-20046869

This article from Mayo Clinic talks about supplements, diet and lifestyle changes that play a role in bone health. However, it does come down to an individual diagnosis and how severe one's osteoporosis is. There may come a point in your diagnosis where supplements and lifestyle changes are not enough on their own to treat your osteoporosis.

There are many products and exercise programs out there today that unfortunately charge very high fees and memberships with promises of curing or reversing osteoporosis that may not be backed by scientific evidence. Be sure to keep your providers in the conversation with any treatment, supplement or exercise decisions you may make regarding your diagnosis.

Hi Maloc,
I too have a forearm reading of -4.1 and when I asked my 2 endocrinologist about taking an anabolic to build bone, both said I was unlikely to increase the density of the forearm because of the bone type there. I have to believe them as one is considered the "expert" in town and the other has a mother with osteoporosis so she probably keeps up with the latest.
I am small boned with arthritis and scoliosis in my spine and the endos consider the DEXA unreliable there which leaves me with only the hip readings to consider. Those are in the osteopenia range and have been stable for several years which seems to please the endos. I just turned 80 and had a Reclast infusion (no side effects) in 2023 and plan a 2nd infusion at year's end or early in 2027 depending on how the bone markers and scan turn out. I also took Actonel and Fosamax in past years followed by a 10+ year drug holiday. Not completely sold that any of this will help avoid broken bones.
For what it's worth, I took a serious fall in the Vancouver airport in January and escaped with only a bruised knee which still hasn't completely healed. The arms that went out instinctively to break the fall survived unscathed. Good luck making your choices going forward. Each of us unfortunately is different.

Thanks so much tor sharing your journey. I am glad you did not have any bad side effects to the reclast infusion. I am considering it but have heard (third party) stories that were horrific. Thanks again for sharing, I am taking your journey into consideration making my own decision!

My forearm radius reading was -3.2 on DEXA. Had bi-lateral hip replacements and bad spine deterioration so no other reference available. Rheumatologist insisted I did not have osteoporosis because DEXA claimed my spine reading was "unremarkable". Indeed, with herniated discs from C-1 thru T-1? Lots of damage from horseback riding fall. She urged me to take a Reclast infusion and avoid Tymlos. I chose to go with Tymlos some 10 months ago. In the interim, I had a REMs scan back in January that gave a lumbar reading of -3.3. Good thing I chose not to listen to the Rheumatologist and instead began Tymlos last September. Difficult to tell how much bone I am forming, but P1NP and NTX show good numbers. I am small boned and I do have osteoporosis. Had osteopenia in 2012 and it clearly worsened. With a reading of -4.1 in your wrist, you might want to consider finding a facility for a REMs scan.