Osteoporosis and Petite Women

On my report it shows my TBS results L1 - L4 = 1.287 (partially degraded microarchitecture) so that is the average of all 4 lumbar vertebrae.

Normal microarchitecture > 1.31

Degraded < or = 1.23

Given that my 1.287 is closer to 1.31 than 1.23 I took that as an awesome sign.

On page one of the report, there is an image of my L1 - L4 called TBS Mapping and the colors are green (high TBS), yellow is in the middle, and red (low TBS) so the image of my spine, or TBS Mapping, shows each vertebrae shaded in these colors to show what my trabecular bone looks like. On page two, there is a chart labeled "Detailed Spine Results" and it lists the TBS for each vertebrae.
L1 = 1.278 TBS
L2 = 1.323 TBS
L3 = 1.342 TBS
L4 = 1.205 TBS
L1 - L4 = 1.287 TBS (the average)

Note, I question the L4 TBS number. From what I have seen, generally, L1 has the lowest TBS, then L2, then L3, and L4 has the highest TBS. Not sure if you are familiar with Dr. Lani Simpson, but she talks about how, often, on DEXAs, the area captured is 'off' and that skews the data. I honestly think that might be going on with my L4.

The DEXA report itself shows:
BONE SITE BMD T-score BMD T-score Adjusted*
Spine: -4.0 -4.8
Femoral Neck: -3.3 -3.6
Total Hip: -2.6 -3.0
*Adjusted for ethnicity, gender, and TBS*.

What exactly does that adjusted mean? Does it mean that they thought my spine t-score was -4.0 but with the TBS added in they now think my spine t-score is almost 1 standard deviation worse, which means instead of 40% less bone than the average 30 year old, they think I have 48% less bone than the average 30 y.o. I mean I really just don't buy that one bit.

I am 4'11''. I haven't had any height loss and I am fracture free. I'm 54 and for the majority of my adult life I weighted be 92 - 101 lbs. In 2016, I gained a few lbs and in 2017 was diagnosed with hypothyroidism for which I take levothyroxine daily. Note, even with the extra weight, my BMI was always w/i range, so I have never been classified as overweight. My current weight is pretty stable at 108 lbs. I joined a gym in January 2022, and I go 3 times a week and between my July 2021 DEXA and my December 2022 DEXA, I significantly increased my lean body mass (muscle).

I am more aware of my movements and shoes with good treads are a high priority for me. I practice hip hinges regularly to remind me to bend at my hips and to avoid forward flexion my spine. I have increased the weights that I use at the gym, what I consider to be a significant amount, over the 1.5+ yrs that I have been going. For ex., I started carrying two eight lb weights when I do the farmers carry (one weight in each hand) and I am up to carrying two thirty lb weights, I am up to 130 lbs on the back extension machine, and 265+ lbs on the leg press (265 lbs is around 2.45x my current weight) and periodically, to challenge my muscles, I take the leg press weights to the max the machine will allows which over 400 lbs.

Any insight you have would be appreciated. I would love to know what your TBS numbers were and if they "adjusted" your t-scores up or down.

The technician who did my scan didn't know anything about DEXA scans. Although I had called and confirmed that the imaging center had a DEXA with TBS capabilities prior to scheduling my scan, when I arrived (after driving approximately 5 hours to get there specifically to get a DEXA with TBS) the technician told me they might not be able to provide the TBS to me. I had the scan done anyway with the intention of writing to the board of directors of the hospital (the imaging center was in a hospital) if they didn't provide me with the TBS numbers. Also, while I was talking to the technician, I mentioned something about t-score of 2 or 3, to which she replied, "that's only 1 point, that's not a big difference." HELLO! That's a 10% difference. That's huge. As the technician predicted, the facility didn't send me my TBS scores after I had the scan. They only sent the standard DEXA info. I had to hound them from several months and it wasn't until I threatened to report the hospital for a HIPAA violition (refusing to provide me with my full DEXA w/ TBS and ancillary data) did I received the information they should have been able to print out and hand to me immediately after having preformed the scan.

Hi, I would be curious to know if your dexa scans have improved since you started lifting weights (i don't understand your scores above so not obvious to me). I am in a similar situation - 5'1" and I lift heavy weights. I also participate in a program called Osteostrong which Ive been doing for 2 years. This past dexa scan I had showed more bone loss, which I was very surprised to see given the fact that I lift heavy weights, I run, and go to Osteostrong. Perhaps what I am missing is supplementation, but I need to figure this out quickly as I moved from osteopenia to osteoporosis range. Looking for advice. thanks!

Hi, I would be curious to know if your dexa scans have improved since you started lifting weights (i don't understand your scores above so not obvious to me). I am in a similar situation - 5'1" and I lift heavy weights. I also participate in a program called Osteostrong which Ive been doing for 2 years. This past dexa scan I had showed more bone loss, which I was very surprised to see given the fact that I lift heavy weights, I run, and go to Osteostrong. Perhaps what I am missing is supplementation, but I need to figure this out quickly as I moved from osteopenia to osteoporosis range. Looking for advice. thanks!

It was brought to my attention in the 1990s a book by Dr John Lee who had his own practice and was excellent in researching and especially with his patients and finding patterns within his clientele.
He wrote a book on menopause and thru observing his patients osteoporosis, he discovered that it could be reversed with progesterone cream.
His writings and experience are worthy to read.
You will have to discuss this with your doctor.

For those who want to Read about Dr. Lee, here is a link for you. I share this for information only so you might discuss this with your doctor after you have read the book.
Dr. Lee, thru his own patients, discovered numerous women who were estrogen dominant. He prescribed the appropriate patients to take progesterone cream. After a period of time, he took these patients bone density tests. Their tests revealed a reversal.
Dr. Lee has since passed away. This is for your interest and information and as always, discuss with your doctor.
https://www.johnleemd.com/

Hi, ebtexas55,
Along those lines, (hormone therapy) I just watched this video by Dr. Doug Lucas, "Little Known Alternative Drugs for Osteoporosis":

@tsc, very informative. Thank you! I love the exchange of info and will go further in reading.
When i was 45 i had my hormones tested. I was very low on testosterone. The female dr prescribed a low dose testosterone cream made by a compound pharmacy.
I was to put a wee bit on the back of my heel bone and a bit on the back of my calf.
I was to do this for a month.
It wasnt for osteoporosis, it was to balance out my pms and pre menopause.
It helped with my mood and libido and had no hair growth on face or body. But a month is all she would put me on it BECAUSE of the side effects.
I will read some more on this.
Thank you so much for sharing.🌺

I am 5'0" and weigh 97 llbs and am nearly 71 years old. I started weight lifting 7-8 years ago around 2015. After starting I saw an increase in one density, mainly in spine, but a some in the hips too. Unfortunately around 2020-22 I had to go on dialysis which is really hard on the bones, as is kidney disease. I had a kidney transplant in late Oct. 2022, and am not trying my hardest to gain back or at least stay where I am after losing one mass on dialysis. In addition to eating a "bone healthy diet" I am back to weight training. I lift very heavy for my smally body. Squat 35 lbs 20 reps 3xweek, deadlift 130 1xweek, at home I jump 200 times a day-not all at once, and a few other exercises for the hip neck. My last dexa, on 11-23 (which I paid for myself) showed I was holding steady compared to a dexa I had on 2-23. So it is likely a result of both weight lifting and nutrition. Also, I have read that dexa sometimes is not accurate for small framed individuals, especially at the hip neck. The next time I get a dexa, I am going to go to a place where they also test the TBS score which measures the bone quality, not just the density. Considering my age, I will be happy if I get a good TBS score and remain the same for bone density. I remind myself a lot that before the dexa machine was invented, people, such as my mother who died at age 97 never had any bone issues. She was very active and ate like people used to eat before we had all the processed foods we have today. It is only my opinion, but since dexa was developed and the pharmaceuticals came out, people did not worry about the "O" word. I also remind myself that a T-score compares oneself to the bone structure of a person in their 30's. As we age, our bone mass naturally decreases. I do know that calcium is not absorbed well unless you have an adequate amount of vitamin K2. Also you need vitamin D for bones. One added piece of info, you are likely gaining muscle through your exercises. Muscle protects your bones and balance--and helps you prevent falls. Weight training is the best for bones. While some cardio is obviously good for your circulation and heart, I try not to do too much, cause I need the calories and the weight on my small body. Plus, weight lifting is also now-days considered a cardio cause it is certainly strenuous on your heart.

Though I have quite a story to tell you how I actually found a very local place (45 minutes or so from my home) that had a machine to perform the DEXA with the TBS , and the technician didn’t even know that they had it till I showed unannounced up to really inquire about that as I couldn’t reach them by phone. In talking to her she realized that the day before a DEXA Report came out looking very different and realized it was a DEXA with a TBS. On the spot we made a plan as to a day to return to have my pictures taken . I returned 3 weeks later and she did a most beautiful job of positioning me and taking the picture that I had ever experienced. She gave me 2 copies of the report on the spot , one for me and one to send to Dr, McCormick, as I wanted to have that extra info when I consulted with him. Just felt like I should let all know there are good experiences and professionals out there that will work with you. But sometimes it does seem far and few between. Most likely due to their lack of understanding, training ,etc. Good luck to you all attempting to secure a DEXA w / TBS!!!

Searching for a location with TBS capabilities, I found that Medimaps Group, the manufacturer of TBS iNsight™ (Osteo) makes available lists of centers by state which use their TBS software. That's how I found the one where I"ll be getting my next scan. I know that it's important to get every scan at the same location for the most accurate comparative purposes, but because my clinic doesn't have TBS, I've decided to change over to a center that does. Even though I knew they use TBS, when I scheduled the scan, I asked them to verify it. The scheduler had no idea what I was talking about. I had to spell out the full name for her. After asking the head of radiology about it, she learned and confirmed that they do indeed use TBS.

Here's the link: https://www.medimapsgroup.com/find-a-clinic-with-tbs-insight-osteo/