1. < Osteoporosis & Bone Health

68 yr. man with -4.9 in L4!

Posted by dk68 @dk68, Mar 13, 2023

A first DEXA has revealed that I have osteoporosis in one my femoral necks (-2.7) and average -4.4 in Lumbar vertebrae (one region was -4.9). I am a small-framed (wrist diameter 6.5") man, just shy of 5'5, 140 lbs. I believe my GP ordered the scan, because my stature is closer to her average post-menopausal patients. It was a good call (she claimed it was because I was underweight (I'm not) and had been treated for prostate cancer). I have, however, no risk factors: normal weight, normal diet, normal exercise, no GERD, no corticosteroids, no HT for prostate cancer (brachytherapy, PSA undetectable), normal testosterone levels, normal thyroid, and no signs in blood of parathyroid issues. She gave me an Rx for Fosamax, told me to gain weight (!), lift weights, take Ca supplements--we'll scan again in 3 years! I've requested that I see an endocrinologist.

Does anyone have experience with Lumbar Numbers like mine? Is my GP being cavalier in her treatment?

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windyshores | @windyshores | Mar 21, 2023
In reply to @dk68 "Million thanks--this is very helpful. My PCP gave me an Rx for Fosamax and told me..." + (show)
@dk68

Million thanks--this is very helpful.

My PCP gave me an Rx for Fosamax and told me we'd scan in 3 years. I thought it crazy with -4.9 lumbar. She is used to treating PM-OP and saw no reason to treat a man differently. There was nothing remarkable in my blood, she didn't think I needed any more tests or scans. Brilliant to refer for the scan, less so in response. I seem to have convinced her that I need to find out why I had this, before a treatment regime. She has agreed to refer me to an endo. A month on, I am still struggling to even get consultation!

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I hope you do not start the Fosamax and can get on Forteo, Tymlos or Evenity asap. If you call an endo, tell the person on the phone what your score is and that it is urgent. Fosamax will not work well or fast enough and may even interfere with the effectiveness of the bone builders. I can't believe your PCP said a scan in 3 years!

You can get on a cancellation list and call at 10 am every few days. Is there an endo clinic you can go to?

REPLY
fearfracture | @fearfracture | Mar 21, 2023
In reply to @dk68 "Million thanks--this is very helpful. My PCP gave me an Rx for Fosamax and told me..." + (show)
@dk68

Million thanks--this is very helpful.

My PCP gave me an Rx for Fosamax and told me we'd scan in 3 years. I thought it crazy with -4.9 lumbar. She is used to treating PM-OP and saw no reason to treat a man differently. There was nothing remarkable in my blood, she didn't think I needed any more tests or scans. Brilliant to refer for the scan, less so in response. I seem to have convinced her that I need to find out why I had this, before a treatment regime. She has agreed to refer me to an endo. A month on, I am still struggling to even get consultation!

Jump to this post

Rheumatologists also treat osteoporosis. I hope you end up with a great doctor but be prepared to be underwhelmed. My endocrinologist is a lot to be desired and I’ve been trying to find another doctor for over a year but so far nothing has worked out.

I have you had a full thyroid panel? Untreated hyperthyroidism will cause low bone density.

REPLY
1 reply
fearfracture | @fearfracture | Mar 21, 2023
In reply to @fearfracture "Rheumatologists also treat osteoporosis. I hope you end up with a great doctor but be prepared..." + (show)
@fearfracture

Rheumatologists also treat osteoporosis. I hope you end up with a great doctor but be prepared to be underwhelmed. My endocrinologist is a lot to be desired and I’ve been trying to find another doctor for over a year but so far nothing has worked out.

I have you had a full thyroid panel? Untreated hyperthyroidism will cause low bone density.

Jump to this post

correction: leaves a lot to be desired. 😂

REPLY
1 reply
fearfracture | @fearfracture | Mar 21, 2023
In reply to @dk68 "Million thanks--this is very helpful. My PCP gave me an Rx for Fosamax and told me..." + (show)
@dk68

Million thanks--this is very helpful.

My PCP gave me an Rx for Fosamax and told me we'd scan in 3 years. I thought it crazy with -4.9 lumbar. She is used to treating PM-OP and saw no reason to treat a man differently. There was nothing remarkable in my blood, she didn't think I needed any more tests or scans. Brilliant to refer for the scan, less so in response. I seem to have convinced her that I need to find out why I had this, before a treatment regime. She has agreed to refer me to an endo. A month on, I am still struggling to even get consultation!

Jump to this post

I also found this article that you may find interesting https://www.webmd.com/osteoporosis/features/male-men

It states:

"If you look at men who lack an enzyme to make even small amounts of estrogen because they were genetically born that way," says Mystkowski, "they get osteoporosis. If you give them estrogen, their osteoporosis improves. So even though estrogen doesn't circulate in very high concentrations in men, it's a critical factor for bone health."

That may be something you should have checked.

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1 reply
2121 | @leslie2121 | Mar 22, 2023
In reply to @fearfracture "correction: leaves a lot to be desired. 😂" + (show)
@fearfracture

correction: leaves a lot to be desired. 😂

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😝

REPLY
dk68 | @dk68 | Mar 22, 2023
In reply to @fearfracture "I also found this article that you may find interesting https://www.webmd.com/osteoporosis/features/male-men It states: "If you look..." + (show)
@fearfracture

I also found this article that you may find interesting https://www.webmd.com/osteoporosis/features/male-men

It states:

"If you look at men who lack an enzyme to make even small amounts of estrogen because they were genetically born that way," says Mystkowski, "they get osteoporosis. If you give them estrogen, their osteoporosis improves. So even though estrogen doesn't circulate in very high concentrations in men, it's a critical factor for bone health."

That may be something you should have checked.

Jump to this post

Thanks, it is very helpful and reassuring review. I am ready for any tests. I've researched the role of sex hormones, especially low estrogen (or inhibition) in some male OP. It doesn't seem that the improved bone mass from treatment with such drugs comes at a cost to our maleness. I have too many miles left on my chassis not to consider anything that will keep it more like a Volvo than a Yugo.

Despite my numbers, I feel fortunate to be frac-free. My heart goes out all of you who have had and are going through the pains of coping with their OP (compounded for many by multiple maladies).

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1 reply
fearfracture | @fearfracture | Mar 22, 2023
In reply to @dk68 "Thanks, it is very helpful and reassuring review. I am ready for any tests. I've researched..." + (show)
@dk68

Thanks, it is very helpful and reassuring review. I am ready for any tests. I've researched the role of sex hormones, especially low estrogen (or inhibition) in some male OP. It doesn't seem that the improved bone mass from treatment with such drugs comes at a cost to our maleness. I have too many miles left on my chassis not to consider anything that will keep it more like a Volvo than a Yugo.

Despite my numbers, I feel fortunate to be frac-free. My heart goes out all of you who have had and are going through the pains of coping with their OP (compounded for many by multiple maladies).

Jump to this post

Fortunately, I don’t have any fragility fractures; however, I’m 54 and my Dec 2022 DEXA lumbar t-score was -3.6.

I did reread your original post and noticed that you said you did have you thyroid checked. Be aware that the range listed on blood tests for “normal” TSH levels is considered by many to be too wide of a range. I have hypothyroidism and my last 2 thyroid panels showed my TSH around 2.3ish and because my T3 is also at the lower end of the ok range and the fact that recently I’ve been tired no matter how much sleep I get, I requested a bump up in my levothyroxine. I’ve been taking 75 mcg/day for a few yrs and starting tomorrow, I’ll be taking 88mcg.

Hyperthyroidism causes excessive bone turnover (resorption). The effects of hypothyroidism on bone is not as well understood, but from my research it seems that hypothyroidism slows bone formation, so it’s not causing excessive bone turnover but since it’s slowing bone formation one ends up with a net loss.

REPLY
dk68 | @dk68 | Mar 22, 2023

54! Yi. I lack key tests in my blood work, specifically PTH (+ a host of others)
My TSH 2/2023 was 1.7 (down from 1.1 2/2022)--Nothing remarkable in Ca, D3, B12, etc., etc.

I have no symptoms of anything (except OCD about OP).

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