DEXA @ 9 mos of Tymlos- worried about rookie tech's technique

Posted by annie208 @annie208, 2 days ago

I had my second DEXA-scan ever last week after 9 months of Tymlos shots. I inject the full "8 clicks" every day, but I mostly inject in the fatty part of my upper/outer thighs (flanks) since my stomach bruises easily and has some scarring from surgeries and accidents. I'm 63 now and had total hip replacement after fracturing my left femur neck 17 months ago.

T Scores:
Lumbar spine improved from -1.8 to -1.1 (+9.8% noted)

Right total hip improved from -2.6 to -2.0 (+11.5% noted)

Right femur neck improved from -2.2 to -1.9 (+4.6%--I did the math and added this percentage--it wasn't noted)

Left forearm got worse from -2.2 to -2.5 (report said year over year comparison wasn't valid for this measurement)

I'm quite happy about these results and was glad to see a boost in total hip if not femoral neck, but the tech frankly didn't inspire much confidence. When she was filling out my pre-scan questionnaire she indicated she'd never heard of Tymlos. Assuming most docs in this market must prescribe rival Forteo or Teriparatide, I asked if she'd heard of those and she said "no." That on its own wasn't so troubling, but then (though she used the same machine as I was scanned on last year) she didn't position me as precisely or give me as thorough of verbal directives as last year's tech had done. Even as she did my scan she was so quick to take the images (without much verbal warning) that I wondered if she was getting the most useful views. Her technique in imaging my left forearm seemed drastically different than last year's tech's.

Last, when the report came back, it said Lumbar Spine, L1, L2, & L4. Last year's report said Lumbar Spine L1, L2, L3, & L4. Why would L3 be left out this year?

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

gently | @gently | 2 days ago

Annie, marvelous results after only nine months.
Vertebra are not included if there is adjacent disc disease, fracture, metal interference, even arthritis that might skew the total scores. Or if you have a rookie tech.
Forearm measurements are not considered as reliable because it is near impossible to measure the exact same spot on the forearm, but also because the changes year to year are small.
That said, people often lose bone density in the forearm and even in the hip on the anabolics because they create a more porous cortical bone. The forearm is about 80% cortical bone. The best cortical bone has cannulations--communication channels between osteocytes that register vibration from activity creating changes in bone structure that protect against fracture.

idlehands | @idlehands | 1 day ago

annie208, yes, great results. I myself wouldn't worry about the rookie not having heard of Tymlos or any medicine in particular. It's not their field of expertise. Most radiology techs are - and I don't mean it critically or judgmentally - just image-takers. They don't read the scan and comment on them, they don't interpret, they usually say 'Your doctor will discuss the results with you' because that's just what they do. I'd be more concerned about the image quality if it's suspect, and address it with the doc. They can always order a retest if necessary.