Treating Osteoporosis: What works for you?

On the effect of body size on DEXA:

Source: https://www.inspire.com/windblown/journal/forteo-results/reply/1478797/......... from a poster called "endodoc" who is a phyician, presumably an endocrinologist:

"Most patients and most otherwise good physicians who never specifically
studied bone metabolism are unaware of the fact that DXA machines do not actually measure BMD. I realize that sounds bizarre, but it is true. If you look at the units for your BMD values on DXA, they are grams per square centimeter (g/cm2). There is no universe where mass/area equals density. D=M/V, in other words, density equals mass over volume. The DXA measures your BMC (bone mineral content), based on the level of x-rays that reach the detector. More mineral in the path of the beam, less x-rays make it to the detector = higher BMC. Less mineral in the path of the beam, more x-rays make it to the detector = lower BMC.

If DXA machines divided the BMC they actually measure by the volume of the bone scanned, the units would be g/cm3, it would actually be measuring density, and we wouldn't be having this discussion. However, they divide the BMC by the area of the ROI (region of Interest) that the DXA and/or DXA tech puts over the image of your bone; hence, the units are g/cm2. If you've ever seen your hip scan, you will see a rectangle that represents the ROI for the femoral neck sub-region. You will see a smaller square box, either close to the rectangle or touching/partially within the rectangle - that's the ROI for the Ward's triangle sub-region.

The problem with DXA being an areal measurement as opposed to a true volumetric measurement is that, as a result, it systematically over-estimates BMD on individuals whose bones are larger than average (think: those 5'10" gals with the the big wrists who played rugby in college), and systematically under-estimates BMD in individuals whose bones are more petite than average (think: those 5'2" gals with the the small wrists and ankles who did ballet in college).

Because of the confound of bone size on DXA, many smallish women have t-scores of < -2.0 when they are at their peak BMD at age 25. So if their T-score is -2.5 at the time they enter the menopause, it's likely (absent other risk factors, like bone toxic drugs or diseases) to represent an approximation of their peak bone mass. Most non-expert physicians, however, make the idiotic assumption that "everyone starts at average" (trust me, half are above and half are below, and with DXA it's only the big-boned folks who are above), so they interpret your baseline T-score of -2.5 at age 50 as if you've already lost 2.5 SD [standard deviations] of your bone mass. This is absurd."

ps this also explains why the heavier strontium makes DEXA look better than it is

On the effect of body size on DEXA: (caveat, if DEXA shows severe osteoporosis and you are small, you still have concerning osteoporosis and fracture risk)

Source: https://www.inspire.com/windblown/journal/forteo-results/reply/1478797/......... from a poster called "endodoc" who is a physician, presumably an endocrinologist:

"Most patients and most otherwise good physicians who never specifically
studied bone metabolism are unaware of the fact that DXA machines do not actually measure BMD. I realize that sounds bizarre, but it is true. If you look at the units for your BMD values on DXA, they are grams per square centimeter (g/cm2). There is no universe where mass/area equals density. D=M/V, in other words, density equals mass over volume. The DXA measures your BMC (bone mineral content), based on the level of x-rays that reach the detector. More mineral in the path of the beam, less x-rays make it to the detector = higher BMC. Less mineral in the path of the beam, more x-rays make it to the detector = lower BMC.

If DXA machines divided the BMC they actually measure by the volume of the bone scanned, the units would be g/cm3, it would actually be measuring density, and we wouldn't be having this discussion. However, they divide the BMC by the area of the ROI (region of Interest) that the DXA and/or DXA tech puts over the image of your bone; hence, the units are g/cm2. If you've ever seen your hip scan, you will see a rectangle that represents the ROI for the femoral neck sub-region. You will see a smaller square box, either close to the rectangle or touching/partially within the rectangle - that's the ROI for the Ward's triangle sub-region.

The problem with DXA being an areal measurement as opposed to a true volumetric measurement is that, as a result, it systematically over-estimates BMD on individuals whose bones are larger than average (think: those 5'10" gals with the the big wrists who played rugby in college), and systematically under-estimates BMD in individuals whose bones are more petite than average (think: those 5'2" gals with the the small wrists and ankles who did ballet in college).

Because of the confound of bone size on DXA, many smallish women have t-scores of < -2.0 when they are at their peak BMD at age 25. So if their T-score is -2.5 at the time they enter the menopause, it's likely (absent other risk factors, like bone toxic drugs or diseases) to represent an approximation of their peak bone mass. Most non-expert physicians, however, make the idiotic assumption that "everyone starts at average" (trust me, half are above and half are below, and with DXA it's only the big-boned folks who are above), so they interpret your baseline T-score of -2.5 at age 50 as if you've already lost 2.5 SD [standard deviations] of your bone mass. This is absurd."

ps this also explains why the heavier strontium makes DEXA look better than it is. Also please don't use this info as a reason to avoid meds if meds are needed!

Good morning @toni7, that is very good news. I hope the appointment goes well. When you have scheduled visits with clinicians, do you prepare a list of your issues and the questions you have about your condition? I am doing that this morning to prepare for a pre-surgery visit to my surgeon tomorrow. Knowledge is power and this is just one way to make sure you are getting helpful information during your visit.

Good luck and if sharing is OK with you, I will be happy to see the report of your visit.
What day is your appointment?

May you be content and at ease.
Chris

I didn't think famotidine made osteo worse, thought it was just the PPI's which my stomach doctor took me off of because of my osteoporosis.

Maybe it is just the ppis. I should talk to my doctors. Thanks!!

Chris, am I correct in assuming that Hologic uses gm/cm² bone density as the unit of measurement and the standard T-zone scald? If so, aren't you in the osteopenic, not osteoporotic, range when looking at lumbar and femur neck numbers? If so, do you need to be taking any meds at the moment or do you need to continue on them because you were (incorrectly) put on them earlier when a doctor used your wrist bone density as the deciding variable?

Hello,
I just joined this group. I am interested in the various ways of treating Osteoporosis without taking the medications. Is that possible? I am 68 and had a DEXA scan with a T-Score of -2.5 in the Spine L1-L4. All my other scores (hip, neck) were not great but better than that. I know that gives me a diagnosis of osteoporosis because it hits the -2.5 mark. Has anyone been able to improve their T-scores without taking the usual prescribed medications?

My appointment is scheduled for August 16th. I have a question ... I posted my question this morning only I don't see it. It's possible I posted on Bones, Joints and Muscles or other places. I don't quite understand how Forteo and Tymlos work. Do these drugs build new bones while breaking down old bones? Or do they build new bones alongside the old bones? Or do they simply make the old bones stronger and more dense?
I do always have a list of questions with me. Needless to say, not all doctors like it. My previous endocrinologist did not like it, he briefly nodded yes or no to one or two questions, then walked out. Whereas my primary physician loves and encourages me to do that. I will post my experience with this new endocrinologist ... I pray he will walk me thru the right path. Thank you for your response.
Have a fantastic day,
Toni

@toni7 Tymlos and Forteo build bone but do not significantly affect resorption. You can google them for a complete explanation of how they work. They work through the parathyroid pathway.

A score of -2.5 is right on the line. It is a personal decision but I would not medicate yet,myself. Look at Lani Simpson MD's Facebook group or pick up a copy pf Keith McCormick's book "Whole Body Approach to Osteoporosis."

I ordered the book, "Whole Body Approach to Osteoporosis" and will be picking it up today from the bookstore. I can't wait to read it and thank you for recommending it to me. My score of -2.5 is for the hip ... that's not the worst. My concern is the spine ... which reads, -2.8 to -3.5. Neck is --3.2
Do you think it's serious enough to start taking medication or should I continue with exercise, vitamins and diet?
I appreciate your help,
Toni