1. < Osteoporosis & Bone Health

Osteoporosis and Petite Women

Posted by njhornung @normahorn, May 16, 2023

The form I completed before going to an osteoporosis clinic asked if I weigh less than 127 pounds. That magic figure supposedly puts one at greater risk. The Endocrinologist I saw commented on how petite I am and asked if I have always been petite. While for a few years my weight was a little higher I am now back to around 100 lbs. Can't get back to my 21" waist, though.

Searching the literature, it seems that being petite is associated with higher T scores and not just post menopausal
Supposedly DEXA takes this into account when height and weight are entered into the software. However, one could be short and have heavy bones or be small boned. The old weight charts at doctor's offices used to take that into consideration. Does anyone have knowledge that DEXA truly adjusts for structure and the high scores are not an artifact of the technique? There is less bone for the xrays to penetrate which could be interpreted as the bone being less dense. Does density determine quality?

I am at the point of not pursuing treatment until I get a better handle on what my risk truly is. My only fractures were a clean break to an ankle when I slipped on ice and a finger playing touch football. Both were many years ago.

Any insight to offer?

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pennykj | @pennykj | Aug 14, 2023

I am petite, but I consider myself strong. I am 70 years old, 5'1.5" and weigh between 108-110 pounds. I consider myself "small boned." After 5 years without a DXA, I had one last March and the numbers scared me considerably. My hips were only slightly osteoporadic, but my spine was -4.5. I then made an appointment with an osteoporosis specialist in Central Florida, who I heard did not "push" prescription medications. The first appointment was 3 1/2 months away. Although I previously had researched osteoporosis and non-medication treatments, I continued with vigor. I read in many places that women with small wrists may have inaccurate DXA scores. I believed it.

After my first appointment with the specialist, I asked her about inaccurate DXA scores for petite women. She said that was wrong. Instead, she started pushing me to start Evenity after the series of blood tests, spine Xray and cardiac screening were complete. I left her office dejected and annoyed that I think she looked at my numbers and not me.

Prior to my second appointment, I learned about Echolight REMS technology and pretty much decided that Central Carolina Othopedic would likely be the location of my second opinion. I had watched a video of a symposium on REMS where the doctor at the facility stated that DXA scores can be inaccurate for petite women (like his wife).

My osteo specialist changed her mind during our second visit and thought that Prolia may be a better choice than Evenity since my bone resorption rate was elevated. I asked her about testing my bone quality. She said that they could test for TBS but insurance may not pay since I had a DXA 5 months ago. I told her I did not care since I was prepared to travel to NC to get a REMS scan. The doctor informed me that she thinks TBS is better than REMS. (I am not sure I believe her, but will get a TBS). It so happens that the DXA in my doctor's other office has TBS software. (I am still dumbfounded that I had to ask for it and it was not offered). I had an appointment for the DXA with TBS last Friday, but it was canceled by the facility the day before "due to scheduling conflict." Hopefully, my appointment this Friday will not be canceled.

Sorry for the lengthy explanation, but I am convinced that my DXA scores are low partially because I am petite. I strength train 3x/week, walk daily, swim every other day, climb stairs daily, practice yoga daily, take supplements and eat healthy. I feel like I am strong and I think I look like I am strong.

I am still trying to read everything I can and am doing my best to avoid osteoporosis medication. In fact, Great Bones by Dr. McCormick should be delivered to me this afternoon.

REPLY
3 replies
loplady | @loplady | Aug 15, 2023
In reply to @pennykj "I am petite, but I consider myself strong. I am 70 years old, 5'1.5" and weigh..." + (show)
@pennykj

I am petite, but I consider myself strong. I am 70 years old, 5'1.5" and weigh between 108-110 pounds. I consider myself "small boned." After 5 years without a DXA, I had one last March and the numbers scared me considerably. My hips were only slightly osteoporadic, but my spine was -4.5. I then made an appointment with an osteoporosis specialist in Central Florida, who I heard did not "push" prescription medications. The first appointment was 3 1/2 months away. Although I previously had researched osteoporosis and non-medication treatments, I continued with vigor. I read in many places that women with small wrists may have inaccurate DXA scores. I believed it.

After my first appointment with the specialist, I asked her about inaccurate DXA scores for petite women. She said that was wrong. Instead, she started pushing me to start Evenity after the series of blood tests, spine Xray and cardiac screening were complete. I left her office dejected and annoyed that I think she looked at my numbers and not me.

Prior to my second appointment, I learned about Echolight REMS technology and pretty much decided that Central Carolina Othopedic would likely be the location of my second opinion. I had watched a video of a symposium on REMS where the doctor at the facility stated that DXA scores can be inaccurate for petite women (like his wife).

My osteo specialist changed her mind during our second visit and thought that Prolia may be a better choice than Evenity since my bone resorption rate was elevated. I asked her about testing my bone quality. She said that they could test for TBS but insurance may not pay since I had a DXA 5 months ago. I told her I did not care since I was prepared to travel to NC to get a REMS scan. The doctor informed me that she thinks TBS is better than REMS. (I am not sure I believe her, but will get a TBS). It so happens that the DXA in my doctor's other office has TBS software. (I am still dumbfounded that I had to ask for it and it was not offered). I had an appointment for the DXA with TBS last Friday, but it was canceled by the facility the day before "due to scheduling conflict." Hopefully, my appointment this Friday will not be canceled.

Sorry for the lengthy explanation, but I am convinced that my DXA scores are low partially because I am petite. I strength train 3x/week, walk daily, swim every other day, climb stairs daily, practice yoga daily, take supplements and eat healthy. I feel like I am strong and I think I look like I am strong.

I am still trying to read everything I can and am doing my best to avoid osteoporosis medication. In fact, Great Bones by Dr. McCormick should be delivered to me this afternoon.

Jump to this post

Thanks Penny for this post. I am 5'2, 100 lbs and have very good muscle mass. My Dexa shows an AP spine T-score of -2.9 and my TBS was normal. My primary said she would prescribe Fosamax but I declined and asked for an appt. with an endocrinologist. She was great and really looked at me, my strength, activity level etc. and ordered blood work, which all came back within normal limits. She agreed we could wait a year, get another Dexa and evaluate. If my insurance does not cover it, I will pay out of pocket. I have increased my protein and also added some strength training through resistance bands and am trying to get back into yoga. My Dexa will not be until February/March but I will update then.

REPLY
healthytoday | @healthytoday | Aug 15, 2023
In reply to @pennykj "I am petite, but I consider myself strong. I am 70 years old, 5'1.5" and weigh..." + (show)
@pennykj

I am petite, but I consider myself strong. I am 70 years old, 5'1.5" and weigh between 108-110 pounds. I consider myself "small boned." After 5 years without a DXA, I had one last March and the numbers scared me considerably. My hips were only slightly osteoporadic, but my spine was -4.5. I then made an appointment with an osteoporosis specialist in Central Florida, who I heard did not "push" prescription medications. The first appointment was 3 1/2 months away. Although I previously had researched osteoporosis and non-medication treatments, I continued with vigor. I read in many places that women with small wrists may have inaccurate DXA scores. I believed it.

After my first appointment with the specialist, I asked her about inaccurate DXA scores for petite women. She said that was wrong. Instead, she started pushing me to start Evenity after the series of blood tests, spine Xray and cardiac screening were complete. I left her office dejected and annoyed that I think she looked at my numbers and not me.

Prior to my second appointment, I learned about Echolight REMS technology and pretty much decided that Central Carolina Othopedic would likely be the location of my second opinion. I had watched a video of a symposium on REMS where the doctor at the facility stated that DXA scores can be inaccurate for petite women (like his wife).

My osteo specialist changed her mind during our second visit and thought that Prolia may be a better choice than Evenity since my bone resorption rate was elevated. I asked her about testing my bone quality. She said that they could test for TBS but insurance may not pay since I had a DXA 5 months ago. I told her I did not care since I was prepared to travel to NC to get a REMS scan. The doctor informed me that she thinks TBS is better than REMS. (I am not sure I believe her, but will get a TBS). It so happens that the DXA in my doctor's other office has TBS software. (I am still dumbfounded that I had to ask for it and it was not offered). I had an appointment for the DXA with TBS last Friday, but it was canceled by the facility the day before "due to scheduling conflict." Hopefully, my appointment this Friday will not be canceled.

Sorry for the lengthy explanation, but I am convinced that my DXA scores are low partially because I am petite. I strength train 3x/week, walk daily, swim every other day, climb stairs daily, practice yoga daily, take supplements and eat healthy. I feel like I am strong and I think I look like I am strong.

I am still trying to read everything I can and am doing my best to avoid osteoporosis medication. In fact, Great Bones by Dr. McCormick should be delivered to me this afternoon.

Jump to this post

I hope you can stand your ground, as they use to say. Another words, trust your intuition. I have a similar situation. I'm 75 with osteroporsis diagnosis. It's probably this way since I've been taking thyroid hormone since my 30's, and at times the amount was too high. So, this is probably what caused it. Also low VitD. Have this vitamin checked. It's low in many people. It needs to be taken in combination with Vit K. (they are combined in supplement). Good luck
The meds have difficult side effects. Study the problem.

REPLY
1 reply
pennykj | @pennykj | Aug 15, 2023
In reply to @healthytoday "I hope you can stand your ground, as they use to say. Another words, trust your..." + (show)
@healthytoday

I hope you can stand your ground, as they use to say. Another words, trust your intuition. I have a similar situation. I'm 75 with osteroporsis diagnosis. It's probably this way since I've been taking thyroid hormone since my 30's, and at times the amount was too high. So, this is probably what caused it. Also low VitD. Have this vitamin checked. It's low in many people. It needs to be taken in combination with Vit K. (they are combined in supplement). Good luck
The meds have difficult side effects. Study the problem.

Jump to this post

Thanks. My vitamin D levels are fine (in fact my osteo doctor told me that my level was too high at 65 (January blood work at PCP) but just right at 64 (blood work ordered by osteo dr in May). I initially backed off my vit D, but then resumed about 1000 IU/day plus Florida sunshine. I also take vit K. I will read Dr. McCormick's book and will travel to get a second opinion (if my numbers remain bad). My quality of life is pretty good right now and the thought of living with headaches, joint pain, gastrointestinal issues, or worse really depresses me. Thanks again for your support and comments. 🙂

REPLY
diane0202 | @diane0202 | Aug 15, 2023
In reply to @pennykj "I am petite, but I consider myself strong. I am 70 years old, 5'1.5" and weigh..." + (show)
@pennykj

I am petite, but I consider myself strong. I am 70 years old, 5'1.5" and weigh between 108-110 pounds. I consider myself "small boned." After 5 years without a DXA, I had one last March and the numbers scared me considerably. My hips were only slightly osteoporadic, but my spine was -4.5. I then made an appointment with an osteoporosis specialist in Central Florida, who I heard did not "push" prescription medications. The first appointment was 3 1/2 months away. Although I previously had researched osteoporosis and non-medication treatments, I continued with vigor. I read in many places that women with small wrists may have inaccurate DXA scores. I believed it.

After my first appointment with the specialist, I asked her about inaccurate DXA scores for petite women. She said that was wrong. Instead, she started pushing me to start Evenity after the series of blood tests, spine Xray and cardiac screening were complete. I left her office dejected and annoyed that I think she looked at my numbers and not me.

Prior to my second appointment, I learned about Echolight REMS technology and pretty much decided that Central Carolina Othopedic would likely be the location of my second opinion. I had watched a video of a symposium on REMS where the doctor at the facility stated that DXA scores can be inaccurate for petite women (like his wife).

My osteo specialist changed her mind during our second visit and thought that Prolia may be a better choice than Evenity since my bone resorption rate was elevated. I asked her about testing my bone quality. She said that they could test for TBS but insurance may not pay since I had a DXA 5 months ago. I told her I did not care since I was prepared to travel to NC to get a REMS scan. The doctor informed me that she thinks TBS is better than REMS. (I am not sure I believe her, but will get a TBS). It so happens that the DXA in my doctor's other office has TBS software. (I am still dumbfounded that I had to ask for it and it was not offered). I had an appointment for the DXA with TBS last Friday, but it was canceled by the facility the day before "due to scheduling conflict." Hopefully, my appointment this Friday will not be canceled.

Sorry for the lengthy explanation, but I am convinced that my DXA scores are low partially because I am petite. I strength train 3x/week, walk daily, swim every other day, climb stairs daily, practice yoga daily, take supplements and eat healthy. I feel like I am strong and I think I look like I am strong.

I am still trying to read everything I can and am doing my best to avoid osteoporosis medication. In fact, Great Bones by Dr. McCormick should be delivered to me this afternoon.

Jump to this post

I was able to track down a TBS scan after lots of searching. I am shrinking and at maximum height I was only 4'11-3/4"! I have shrunk over an inch and I am dismayed to say the least. I also heard that DEXA scans are not accurate for small boned, petite women. I also asked for a baseline CTX, bone marker blood test to measure bone resorption in case I decide I have little choice but to start taking an RX. Prolia was suggested to me. I am terrified of doing that but I am afraid of spinal fractures especially, with T score of -3.3 in my spine. Good luck to you. I hope the TBS turns out to be useful for both of us

REPLY
njhornung | @normahorn | Nov 23, 2023

I decided today to look up info on height and weight of top female gymnasts. From photos, Simone Biles seems to have a moderate bone structure while Gabby Douglas appears to be more fine boned.

Simone 4'8" and 104 lbs.
Gabby. 5'2" and 108 lbs.

Wouldn't you love to know their DEXA scores? (Sticking a landing would be worth many heel drops). It would be interesting to see if the DEXA properly corrected for their height and weight or if they are considered to have osteopenia

REPLY
ibis3 | @ibis3 | Nov 24, 2023

Thanks Ladies for all your thoughts, experiences and thoughtful consideration of this important health issue. I’m a petite, 75 year woman who, like many of you, are attempting to tread the choppy road of refusing meds for my osteoporosis. I’m optimistic after hearing your stories. I’ll get the book, go see an Osteo doc and continue my healthy diet, exercise program. 🙏 This group gives me hope. I’m grateful.

REPLY
1 reply
drsuefowler | @drsuefowler | Nov 24, 2023
In reply to @ibis3 "Thanks Ladies for all your thoughts, experiences and thoughtful consideration of this important health issue. I’m..." + (show)
@ibis3

Thanks Ladies for all your thoughts, experiences and thoughtful consideration of this important health issue. I’m a petite, 75 year woman who, like many of you, are attempting to tread the choppy road of refusing meds for my osteoporosis. I’m optimistic after hearing your stories. I’ll get the book, go see an Osteo doc and continue my healthy diet, exercise program. 🙏 This group gives me hope. I’m grateful.

Jump to this post

I am also petite, 5 ft 3 inches and 107 lbs. I used to weigh less than 100 lbs before I started breaking bones and became less active. I have tried the natural way for 10 years, and was so against taking the medication. Last year I fell twice, breaking my ankle and hand. This year I fell 3 times, breaking my shoulder, ankle and suffering a concussion. I am now taking 20 mcg of Tymlos, 1/4 a dose. That is all I can tolerate, but my endocrinologist says that any amount will help. My DEXA scan is scheduled for next month. I wonder if anyone can explain what TBS and CTX mean.

REPLY
1 reply
hopefullibrarian | @hopefullibrarian | Nov 24, 2023
In reply to @drsuefowler "I am also petite, 5 ft 3 inches and 107 lbs. I used to weigh less..." + (show)
@drsuefowler

I am also petite, 5 ft 3 inches and 107 lbs. I used to weigh less than 100 lbs before I started breaking bones and became less active. I have tried the natural way for 10 years, and was so against taking the medication. Last year I fell twice, breaking my ankle and hand. This year I fell 3 times, breaking my shoulder, ankle and suffering a concussion. I am now taking 20 mcg of Tymlos, 1/4 a dose. That is all I can tolerate, but my endocrinologist says that any amount will help. My DEXA scan is scheduled for next month. I wonder if anyone can explain what TBS and CTX mean.

Jump to this post

My size is almost identical to yours, and I'm trying to get tests to narrow down the cause of my bone loss, as well as my true fracture risk at this point. I'm learning about these things in order to be able to have an informed discussion with my doctor on my course of treatment.
Because I'm petite, I feel that I need to be extra cautious.

Dr. Keith McCormick's book, Great Bones is the osteoporosis "Bible" which includes detailed explanations of all of the tests, how and when to use them, and why they are important.

Just last night I watched a YouTube video of an interview with Dr. McCormick hosted by Dr. Margie Bissinger titled "Bone Turnover Markers and Osteoporosis. It does a great job of explaining the various tests.
You can view it here: https://youtu.be/eZIgvcM9Ous?si=l9yyn4BhkeXPV31X.

Based on my understanding of each, I'll summerize what TBS and CTX are.
TBS (Trabicular Bone Score) is a measure of bone quality done through a software add-on used during your DEXA scan. It measures bone quality. TBS combined with your T-score provides a better indication of your fracture risk than the T-score can on its own.
CTX (C-terminal telopeptide) is a measure of how quickly your bone is breaking down (resorption/osteoclastic activity). This is helpful before treatment to narrow down the cause of bone loss, and as a measure of the effectiveness of treatment.

Here's some info on both directly from the Mayo Clinic:
TBS:https://www.mayoclinic.org/medical-professionals/endocrinology/news/new-tools-to-predict-fracture-risk/mac-20430573
CTX: https://www.mayocliniclabs.com/api/sitecore/TestCatalog/DownloadTestCatalog?testId=83175

REPLY
2 replies
drsuefowler | @drsuefowler | Nov 24, 2023
In reply to @hopefullibrarian "My size is almost identical to yours, and I'm trying to get tests to narrow down..." + (show)
@hopefullibrarian

My size is almost identical to yours, and I'm trying to get tests to narrow down the cause of my bone loss, as well as my true fracture risk at this point. I'm learning about these things in order to be able to have an informed discussion with my doctor on my course of treatment.
Because I'm petite, I feel that I need to be extra cautious.

Dr. Keith McCormick's book, Great Bones is the osteoporosis "Bible" which includes detailed explanations of all of the tests, how and when to use them, and why they are important.

Just last night I watched a YouTube video of an interview with Dr. McCormick hosted by Dr. Margie Bissinger titled "Bone Turnover Markers and Osteoporosis. It does a great job of explaining the various tests.
You can view it here: https://youtu.be/eZIgvcM9Ous?si=l9yyn4BhkeXPV31X.

Based on my understanding of each, I'll summerize what TBS and CTX are.
TBS (Trabicular Bone Score) is a measure of bone quality done through a software add-on used during your DEXA scan. It measures bone quality. TBS combined with your T-score provides a better indication of your fracture risk than the T-score can on its own.
CTX (C-terminal telopeptide) is a measure of how quickly your bone is breaking down (resorption/osteoclastic activity). This is helpful before treatment to narrow down the cause of bone loss, and as a measure of the effectiveness of treatment.

Here's some info on both directly from the Mayo Clinic:
TBS:https://www.mayoclinic.org/medical-professionals/endocrinology/news/new-tools-to-predict-fracture-risk/mac-20430573
CTX: https://www.mayocliniclabs.com/api/sitecore/TestCatalog/DownloadTestCatalog?testId=83175

Jump to this post

Thanks so much @hopefullibrarian! The video was very helpful and I
appreciate your description of TBS and CXT. It looks like I should ask for
TBS with my DEXA and get Dr McCormick book.

REPLY
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