Should I pursue a TBS score?

Posted by katwhisperer @katwhisperer, Dec 3, 2022

Hi all: my first post, although been lurking a while. What a terrific forum and kind group of people! I've read a few articles touting the growing value of TBS as a complementary tool to DXA, given its ability to measure bone strength. Wondering if anyone here had it done and if it yielded insightful results?

My first baseline DXA this past spring yielded -3.0 (back). Tymlos was recommended since I have major dental issues. I am 55, extremely fit with 35+ years of daily weight training and fairly high protein/clean eating - but am small framed. Could my bones be low density but stronger than avg thru decades of weight bearing exercise? Perhaps if my bones WERE stronger, even though less dense, I could maybe stall starting on these pharma solutions for a year or two?

I asked my PCP: he never heard of TBS. My rheumotologist dismissed it: didn't feel it would change his recommendations. Neither seems to want to write an RX for another DXA.

The facility for my 1st DXA can't do TBS or I'd just have them add it. No one will add a TBS score to an existing DXA unless it was done at their facility- and I need an RX to get a new DXA.

I was slated to start Tymlos this month. Do you think it's better to pause, find a new doc willing to write a DXA RX and see what the TBS reveals, before committing to a lifetime regimen of drug therapy (I have no clue what I'll be able to take after Tymlos, given my dental problems, which worries me.)

Any opinions most welcome! 🙂

Interested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.

@lynnhaz

I’m not sure it really works that way you’d have to see the amount of content they have to understand what they have to offer it’s hard to describe how much they have. Each person then has a choice to use as much or as little as they’d like. They have a PhD physical therapist for example that worked for the osteoporosis foundation for years and has her own Pilates for osteoporosis who teaches bone strethening exercises what’s safe what’s not safe, along with a nutritionist, a woman’s health functional medicine practitioner, and several other coaches it’s hard to explain unless you see it for yourself. When I try to describe it to other people it’s always inadequate

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I just signed up for the 7 day course.

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@sheilad1

I just signed up for the 7 day course.

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oh great! Im not sure what he includes in the 7 day course...I hope you get a glimpse of the amount of content. Im not sure if you will, since i had no idea of the extensiveness until after i signed up. It is expensive but totally worth every penny and more. Looking forward to seeing what you think! LH

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I looked into TBS also, and actually found 4 places here in AZ that does it. Unfortunately, after i got my PCP to order it I found out that 2 of them dont have the technology, one was at the VA, and the other one is down in Tucson which is 2 1/2 hours away. If anyone knows of a facility here in Phoenix that does have TBS technology, I would really appreciate you sharing where. It is amazing technology...a great way to compliment the DXA, as it measures Bone strength, not bone density...LH

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@lynnhaz

I looked into TBS also, and actually found 4 places here in AZ that does it. Unfortunately, after i got my PCP to order it I found out that 2 of them dont have the technology, one was at the VA, and the other one is down in Tucson which is 2 1/2 hours away. If anyone knows of a facility here in Phoenix that does have TBS technology, I would really appreciate you sharing where. It is amazing technology...a great way to compliment the DXA, as it measures Bone strength, not bone density...LH

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correction!! The two facilities actually do TBS, even though the staff I spoke to said they dont. A supervisor actually called me and said they have the software, but not many of the employees know about it. So, Evernorth here in Phoenix does have TBS. You have to schedule a DXA and ask for TBS along with the DXA. They cant do TBS just by itself.

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Hi, @lynnhaz, first of all I wish you so much luck on your journey! It sounds so like my own. I've also worked out my entire life but have a very small frame, but have massive dental issues so, like you, I've been pursuing non-drug options. I ended up going to University of Pennsylvania Hospital for a combined DEXA/TBS, with high hopes that all the years of exercise, power walking, and good nutrition would show that my bones were strong, even if not dense. Unfortunately, the TBS confirmed that at least one of my spinal vertebrae was "degraded," and others were just on the border. It was a total gut punch. So now I'm putting on my big girl panties and will talk to my endocrinologist about "least bad" drug options for those of us with major dental issues. I am praying there's something I can live with. All I know is that I've been strong and independent my entire life and I HAVE to keep my bones in shape so I can go on living as I always have. I hope you can find a TBS facility near you. Knowledge is power -- either way. BTW, the cost of the TBS was pretty low, just in case your insurance doesn't cover it. This, from American Bone Health: TBS costs depending on the practice, "are as little as $25 or as much as $150." The TBS devise is attached to DEXA scan. You may need to ask your doctor for a note indicating "medical necessity" so you can have your DEXA/TBS covered if you don't want to wait a full year (or two) from your last scan. Let us know how you do, and GOOD LUCK!!

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The shirt answer is YES get a TBS score. A DEXA scan alone is not as accurate and predicting the chances of a fracture. You definitely made both if you can get it.
The long answer is YES YES YES YESA DEXA scan alone is not as accurate and predicting the chances of a fracture. You definitely made both if you can get it.

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@naomid

Hi, @lynnhaz, first of all I wish you so much luck on your journey! It sounds so like my own. I've also worked out my entire life but have a very small frame, but have massive dental issues so, like you, I've been pursuing non-drug options. I ended up going to University of Pennsylvania Hospital for a combined DEXA/TBS, with high hopes that all the years of exercise, power walking, and good nutrition would show that my bones were strong, even if not dense. Unfortunately, the TBS confirmed that at least one of my spinal vertebrae was "degraded," and others were just on the border. It was a total gut punch. So now I'm putting on my big girl panties and will talk to my endocrinologist about "least bad" drug options for those of us with major dental issues. I am praying there's something I can live with. All I know is that I've been strong and independent my entire life and I HAVE to keep my bones in shape so I can go on living as I always have. I hope you can find a TBS facility near you. Knowledge is power -- either way. BTW, the cost of the TBS was pretty low, just in case your insurance doesn't cover it. This, from American Bone Health: TBS costs depending on the practice, "are as little as $25 or as much as $150." The TBS devise is attached to DEXA scan. You may need to ask your doctor for a note indicating "medical necessity" so you can have your DEXA/TBS covered if you don't want to wait a full year (or two) from your last scan. Let us know how you do, and GOOD LUCK!!

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If you have TBS in your area, how do you convince your doctor to order this test? They all seem to rely on the DEXA as the "gold standard" and don't want to waste time with misc tests. It's so frustrating!

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@naomid

Hi, @lynnhaz, first of all I wish you so much luck on your journey! It sounds so like my own. I've also worked out my entire life but have a very small frame, but have massive dental issues so, like you, I've been pursuing non-drug options. I ended up going to University of Pennsylvania Hospital for a combined DEXA/TBS, with high hopes that all the years of exercise, power walking, and good nutrition would show that my bones were strong, even if not dense. Unfortunately, the TBS confirmed that at least one of my spinal vertebrae was "degraded," and others were just on the border. It was a total gut punch. So now I'm putting on my big girl panties and will talk to my endocrinologist about "least bad" drug options for those of us with major dental issues. I am praying there's something I can live with. All I know is that I've been strong and independent my entire life and I HAVE to keep my bones in shape so I can go on living as I always have. I hope you can find a TBS facility near you. Knowledge is power -- either way. BTW, the cost of the TBS was pretty low, just in case your insurance doesn't cover it. This, from American Bone Health: TBS costs depending on the practice, "are as little as $25 or as much as $150." The TBS devise is attached to DEXA scan. You may need to ask your doctor for a note indicating "medical necessity" so you can have your DEXA/TBS covered if you don't want to wait a full year (or two) from your last scan. Let us know how you do, and GOOD LUCK!!

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I am in the same shape as you. Very small frame and lifted weights and worked out but still need drug assistance. I have an odd dental thing going on so I have been told it’s tymlos or forteo. Best wishes to you!

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Same here! I am 58 small stature and Workout out everyday. I was absolutely shocked at my score(-3.4). Have Osteo in ALL areas. In fact according to my docot I've already shrunk 1/2 inch! Going to begin Tymlos. Doctor recommended I refrain from crunches, Russian twists, and anything with twisting or bending. Also have a script for physical therapy. Dexa did not have TBS option. Insurance will not cover a second Dexa so I can get the TBS score. Is this something I can pursue with my insurance company? Thoughts? Suggestions? Ty!

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@leeosteo

If you have TBS in your area, how do you convince your doctor to order this test? They all seem to rely on the DEXA as the "gold standard" and don't want to waste time with misc tests. It's so frustrating!

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The TBS is software that is used in the same machine as the DEXA test. They dud both at the same time. If you had a scan less than 2 years ago if the doctor writes "medically necessary" insurance should cover the DEXA scan. The TBS was an additional $50 to me, our if pocket. If your doc diesnt know the huge benefits of a TBS or Echolight scan I'd find a better doctor.

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