Can a DEXA be accurate when you’re healing from a spinal fracture?

The DEXA scans L1-L4 usually. For lumbar fractures the technician usually omits the fractured vertebrae. As far as I know a T12 wouldn't pose a problem.

Dxa wouldn't be reliable at T12, but they don't measure T12 and wouldn't measure a fractured vertebra. A fractured T12 could result in increased pressure at the lumbar level. We sometimes lose trabecular bone long before it is evidenced as pain or compression. If the lumbar spine is showing bone loss, you might consider an osteoporosis medication.

I really have a ballpark mentality about DEXA's! And comparing from one DEXA to another rather than going on values from one might be more useful. Though mine jump around a bit. The technician can affect the results, in terms of positioning for instance. We want the same " area of interest" but don't always get it.

Hi All,

To speak about interpreting my most recent DEXA where my L1 went to -1.0, I can relate the following:

Although I’ve been told and have read that a DEXA should be done on the same machine from one scan to the next (mine was not) I chose to accept my most recent scan as “the” scan after Tymlos, Evenity, and Reclast. I’m cool with that.

When reviewing the numbers with my rheumatologist, he stated he wasn’t surprised that the L1 had improved so much as it had been fractured and would be stronger. However, L1 was also fractured two years previous without the amazing improvement.

I agree that a different technician and/or machine may scan our bones at a slightly different angle, time of day . . . hence different values in different areas in different years.

One other thing I noticed - the tech who read my last two DEXA’s noted that (paraphrasing) “this patient is susceptible to frax, recommend ANNUAL scan to follow progression . . .”. Who among us has been “treated” to an annual DEXA scan? And, if we want an annual scan, is it paid for (language in Medicare seems to say yes based on the condition of OP), or if it isn’t a covered expense, can we get the scan and pay for it out of pocket?

Thanks for listening! Hoping that old Punxsutawney Phil does NOT see his shadow in a few days and we can begin to enjoy the warmth of spring.

Cheers!

Hi @gently, Could you explain what you meant when you said that a fractured T12 could result in increased pressure at the lumbar level?

Just trying to understand how my T9 and T11 fractures might impact my lumbar spine and possible affect my Dexa score.

Thanks.

@mary1951 like I said, I have a ballpark attitude to DEXA's. I have a chart since 2006. I don't think any of us, but especially those of us with fractures, can be perfectionist about results.

I would ask your doctor or the radiologist if you are really concerned. Fractured bone and arthritic bone look denser, I have been told, but I do not know anything about the effect of other structural changes to the spine as a whole.

I still trust my DEXA's in a sort of holistic fashion, even with 7 fractures.

hi mary1951,
Changes in vertebral weight with fracture may cause further loss of bone in the lower lumbar vertebra.
Vertebral fractures heal in a compressed state (most usually anterior) causing an alteration of pressure on subsequent vertebra.
With osteoporosis we "silently" lose connecting bone in the lacy trabecular network. Dxa tells us we are losing density, but we feel great until we lose enough of those delicate connections and the vertebra collapses. But I understand you are planning anabolic rescue.
I see how my post was vague and welcome your question.

I have read (McCormick I think) that once those connections are disrupted, they are not recoverable. So someone like me can increase bone density but not all aspects of bone quality. The connections sort of look like stalagmites and stalagmites once disconnected.

windyshores McCormick (or whoever) is probably right and the medications may only strengthen the remaining structures, but I was on an interesting thread from newer microscopic studies that described the restructuring of the collagen scaffolding with anabolics if started before compression.
They haven't a way to restore the configuration of the crushed spicules

I certainly hope scaffolding can be restored at vertebrae that have not been fractured!