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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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@daisy17 my doctor didn’t sound too promising. She feels it would be 5 years before I may go from -4 to -3. I’m really counting on my diet and exercise. Ive started drinking fresh goats milk, did some research on that. Eight oz. A day. I really hate the thought of being on Prolia or any of the prescribed drugs. It’s there to help but not cure and coming off it is a challenge to. But thinking positive and trying to stay informed and learning a lot here in this great forum! Best wishes
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1 ReactionYes, you’ve been seeing the wrong doctors if you want an x-ray! The x-ray comes from the orthopedic department. The reason they don’t do the x-ray in the endocrine department or with your primary care doctor is because they can’t interpret the read only an orthopedic doctor can do that.
Unfortunately, our medical system is really screwed up and you don’t get sent to the doctors you really need to see. They are expensive. So they put you through a hamster wheel and hope that something along the way will help. And the things they do have only if they show you to be an extreme outlier will they send you to the doctor you need to go to.
I’ve had multiple surgeries and I could tell you that all these tests are just guessing games and they don’t really know the state of your bones until they open you up on the surgical table. That’s just the reality. X-rays are a really easy and cost-effective way to see arthritis and erosive conditions and density. However, from my understanding and experience, they fail at seeing hairline cracks.
My C5 fell apart on the operating table after 30 years of DEXA, which told me my bones were in pretty good condition. Make sure you have good doctors who will explain to you what you need to know and help you stay on the right path.
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3 Reactions@cmbaczenski I’m sorry that you have had such really tough experiences….the medical world hasn’t had a lot to offer people with OP…toxic meds that many can’t take or tolerate…there are some things we can try to at least stabilize whatever our condition is … diet, well chosen supplements, simple exercises for balance and strength. And in general, enough caution to avoid falls. Medicare does help, no question. There are glimmers of hope..when you post here, you will get very good support and info. Wishing you better days !
@loriesco Wow, what a lot of info. Thank you for explaining the limitations of xrays - I didn't know any of this. The learning curve seems to get steeper and steeper! Thank you so much for sharing your experiences and wisdom. I will definitely take to heart the advice to seek good doctors.
An addendum to my original post: after the doctor reading the spine x-rays told me I had compression fractures, I sought out two radiologists for their opinion on that finding. Both of the radiologists said I have had NO compression fractures - the x-rays were misread by the original doctor. They do agree about their being bone spurs and indeterminate arthritis of spine.