Is a dexa every 2 years enough?

@jozer the DEXA doesn’t really impact the bone medicine protocol. The same with the CTX/P1NP. I like them because I like to look at my test scores and see if there are trends. But I also understand that the DEXA is vague in general and they didn’t tell me my bones were gonna fall apart in cervical spine surgery! Make sure the DEXA test that you get has the TBS analysis with it and keep taking those bone meds!

@loriesco yup found out that dexa doesn’t change treatment protocol from my doc, but we will do a dexa after 2 years of treatment. However if after a year of reclast there is zero change in BMD (from pre reclast dexa) wouldn’t be practical to discuss changing treatment? And before I reluctantly took reclast (which for me was basically side effect free) my doc and I discussed the possibility of only having to have one infusion; he said possibly so how do we know how to move forward with another infusion without testing? I have found through this fun journey that it is all so vague, hard to know what to do from choosing specific doctors who treat to lifestyle to tests to supplements.

@jozer the DEXA with TBS are favored because the analysis is consistent from year to year. Unfortunately, the deck says without TBS aren’t consistent. They are vague. So continue with the protocol. I suggest doing all the research yourself and bringing it to your doctor and discuss it in an informed way. For me there was a tremendous amount of side effects on the Reclast. However, it was done three weeks out of two major surgeries three weeks apart from each other. That probably had something to do with it. Also, I believe that my severe reaction was due to the fact, my body needed the medication. The area where I had, the severe reaction was at the area where I had the cervical spine surgery and my bones fell apart. My 30 years of DEXA not prepare anybody for my bones falling apart during surgery. After much exploration with my fantastic orthopedic surgeon as well as members from this group, I learned that this isn’t an exact science. The best thing is to prepare as much as possible with the things that are available and let good doctors be your guide and your own research. Although I have a great orthopedic surgeon, I was less than satisfied with the endocrinology department where I found myself for the bone medicines. I ended up calling the pharmaceutical company and pushing the nurse practitioner and coming up with a better plan then if I had left it to them alone. I did not show great response in the first two years, but I am hopeful that with a more strange policy of injecting the Tim Lowe’s into my belly as opposed to my thigh and belly I’m going to show better response this fall when I test again. I also introduced BHRT a year and a half Ago a very modest amount because cancer runs in my family. There’s no way around building bones at 69 years old without hormones exercise, the bone medicines and a good diet. But it was explained to me why the tests aren’t necessarily a great gauge. I saw it for myself with the DEXA. Now I do a DEXA with TBS, which shows that I have osteoporosis. The DEXA without showed that I had come out of osteopenia to being normal. That is because the machines aren’t calibrated to one another. I don’t believe that paying people money for bone supplements and bone exercises and such are gonna benefit anyone. I have a strong science background from college and the process of building bones needs hormones and a younger body. I can add a few hormones, but I can’t add the younger body. And I also cannot change my genetics, but I can do exercise to offset them!

My doctor actually laughed when I requested a ctx and p1np.
I insisted. I told him he didn't have to read it. I just wanted the results so this group and Dr McCormick could help me with my numbers. I definitely would fight for it these medicines are strong and you want to make sure they're working before 2 years down the road you find out you're sick and they don't. Plus you can get aDexa scan yourself. Just get the referral. Tell them you will be a Cash pay. Again insist it. They're only $85-100
Best Regards

@loriesco thanks so much for your insight…sure are a lot of moving parts! Trying to find dexa with tbs, but all centers need a referral and my current (doctor referred) dexa center doesn’t do tbs (never heard of it per technician). Not sure how I’d get a referral to a center of my choice (one with tbs) without my docs blessing!

@jozer We are going through the same type of thing with DXA referral with TBS. Once we got a referral to a DEXA/DXA testing place with TBS they wanted to charge $200 extra for the TBS because the doctor had not included that in the order. We are still working with the doctor & TBS to get past this.

Here is a page that shows the CPT reimbursement codes needed by CMS related to TBS.
https://www.medimaps.ai/trabecular-bone-score-reimbursement-2/
And here is a paper that you could give to your doctor some guidance. The title is a whole paragraph itself! Read the paper carefully first as it is not the blanket "TBS is now the standard of care to help understand what the heck is going on" statement that I would like to see. 🙂

"Update on the clinical use of trabecular bone score (TBS) in the management of osteoporosis: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), and the International Osteoporosis Foundation (IOF) under the auspices of WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging"
https://pmc.ncbi.nlm.nih.gov/articles/PMC10427549/
EXCERPT: "The expert consensus statements and operational approach, provided in this paper, can be used to guide the integration of TBS in clinical practice for the assessment and management of osteoporosis."