Mild osteoporosis DEXA scores: what would you do?

Posted by prettyflower @prettyflower, Jan 8 9:46am

I posted this question earlier, which was about mild vs. severe DEXA scores. Replies seemed to veer off pretty quickly, lol, so I'm starting again. My last DEXA in May 2023 was a -2.7 spine, and during a surprisingly quick appointment a new doctor (an endo) said to go with Prolia. Background: I had been on Fosamax for over 4 years based on a -2.5 score. I had an initial slight improvement then it dropped to the -2.7. After reading quite a bit on this forum and elsewhere, I don't think my scores warrant Prolia. In fact, I've decided not to go on any medication until May of this year, when I will pursue another DEXA on a TBS-equipped machine. I will consider it my new baseline. My last two DEXAS were on different machines. What are your thoughts about scores, and when it becomes really necessary to treat with meds? Would anyone else here approach it as I am, by waiting a year for another DEXA with TBS?

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@janieben

I am 72, living in NE KS. I have all my parts intact, have never been on HRT. Recently had a DEXA scan: Spine - mineral density of 0.975 grams/cm squared. This is a T-score of-1.8. Femoral necks - demonstrate a bone mineral density of 0.628 grams/cm squared. This is a T-score of-2.9.
My primary mentioned treatment with prolia or fosamax, but was unclear as to any side effects, etc.
He never mentioned HRT.
Does anyone know of a specialist of any kind in this area (NE KS, KC, or NW MO) I could see about guidance and advice?

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Personally I would wait on meds. But some docs are prescribing for mild osteoporosis. Keep in mind that the front line drugs, Bisphosphonates and Prolia, can affect the effectiveness of the bone builders, Forteo, Tymlos and Evenity. Also, if you start Prolia it is hard to stop: you have to transition to a bisphosphonate to avoid rebound bone loss. Everyone makes their own decisions so I am just sharing what I would do, not necessarily what you will do! I am known around this forum as a proponent of meds, usually!

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@teb

The two do not equate and that wasn't my intent to suggest that. They are not equivalent approaches but both approaches include the risk of additional bone loss. I can't even stress how important and how big a focus diet and exercise is for me in my life so if my statement inferred otherwise, then I did not communicate it correctly.

We all lose bone starting in our 30s and once we hit menopause, the drop is precipitous with some of us being faster losers than others. Diet and exercise are essential and a necessary adjunct to some type of medication if the loss is great. I'm a very health conscious person, was a dancer, weight trained, and ate a healthy diet of all organic food so my diagnosis was a big shock to me. I was determined to address my bone loss naturally and so I went all in, adding to my daily exercise program, standing at my computer, heel bumps, prunes, hiking, lifting weights, etc, and calculating my nutrition every day to make sure I met all goals, supplementing when I did not. I could not possibly have done much more. The additional loss I suffered during that 2 year diet and exercise trial was really detrimental and I share that experience so that others hopefully won't suffer that same fate.

I have always believed in consuming a healthy, nutritious diet and having a well rounded exercise program and I still do all of those things religiously in addition to the pharmaceuticals that helped me build back what I lost and subsequently maintain. A healthy lifestyle is important not just for our osteoporosis but for how we want to function and live as we age. They are just not very likely to build bone on their own once you're past peak bone mass and starting to lose bone naturally.

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Exactly my experience.

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@,prettyflower I think you are doing exactly what I would do. Your values aren’t that bad , you have time to figure out a plan. And I personally would not go on Prolia after all I’ve read and understand about it. are you doing other things to help your situation like appropriate exercise, eating well, getting the protein you need, , taking supplements that are indicated, managing stress , getting good sleep, etc…. I think getting a DEXA with a TBS is a great plan. Some people, not saying this is you , but if they begin to understand what the root cause of why they are losing bone becomes known they can really help their situation and may not need drugs. It all depends. Finding out the root cause I’m told is best to work with a Functional/Integrative physician. And I would suggest getting a copy of Dr Keith McCormick’s book. And there’s a great place to learn all things about osteoporosis this upcoming week. Go to https://morebone health.byhealthmeans.com/?idev_id=30380. And if you don’t have time at least go to a podcast by Margie Bissinger put out on Jan 4 , 2024 with Craig . Title is something like - Osteoporosis 101 with Craig and Margie Bissinger. Good luck to you!!!!

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@prettyflower

Thank you, @windyshores! Yeah, the endo cited insurance limitations but had not actually investigated it. The only drug that was allowed at the very beginning was Fosamax. I did just buy the McCormick book The Whole Body Approach to Osteoporosis. Excited to delve into it!

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I have The Whole Body Approach too. Because it came out in 2008, you won't find much information in it about Prolia - that should be remedied in his newest book Great Bones which I have not had the chance to read yet

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My numbers are similar to yours and I’m not worrying about it unless I start to get fractures easily. I broke one bone my entire life and I’m 65! I do pretty intense strength training (trainer led with 6 women - most aged 40ish) and I started Osteostrong (heavy load). Once a week. Many women who go there (some traveling 2 hours to get there) have seen big improvements. I also take Algacal. I’ll retake my Dexascan (same place) in 2 years and see what happens. My OB/Gyn really put my mind at ease. The Osteoporosis doctor appt scared me like crazy and immediately suggested drugs. That’s ridiculous. IMO. That said, if a break a bone - just stepping off a curb - I’ll adjust my plan. Maybe.

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@dmalone20

My numbers are similar to yours and I’m not worrying about it unless I start to get fractures easily. I broke one bone my entire life and I’m 65! I do pretty intense strength training (trainer led with 6 women - most aged 40ish) and I started Osteostrong (heavy load). Once a week. Many women who go there (some traveling 2 hours to get there) have seen big improvements. I also take Algacal. I’ll retake my Dexascan (same place) in 2 years and see what happens. My OB/Gyn really put my mind at ease. The Osteoporosis doctor appt scared me like crazy and immediately suggested drugs. That’s ridiculous. IMO. That said, if a break a bone - just stepping off a curb - I’ll adjust my plan. Maybe.

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@dmalone20 I agree with watching and waiting but do caution anyone to avoid waiting until you fracture easily. Even one fracture can be chronically painful and disabling. By all means monitor DEXA's and maybe blood tests as well (get a baseline) but don't wait for a fracture! From someone who knows from experience!

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I would wait before starting medications. You can be
doing other things to try to support your bones, diet,
weight bearing exercise (jumping), and continue to track your bone density with DEXA scans. All the medications have significant side effects and lock you in to treatment for a lifetime. I started Evenity with a bone density of -3.2 and -3 respectively in my hips, and negative 2.1 in my spine. After a year of treatment I had very minimal improvement in my hips, and some better in my spine, but I am sorry I ever started. So now I am off all meds and trying more holistic approach.

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@ans

@,prettyflower I think you are doing exactly what I would do. Your values aren’t that bad , you have time to figure out a plan. And I personally would not go on Prolia after all I’ve read and understand about it. are you doing other things to help your situation like appropriate exercise, eating well, getting the protein you need, , taking supplements that are indicated, managing stress , getting good sleep, etc…. I think getting a DEXA with a TBS is a great plan. Some people, not saying this is you , but if they begin to understand what the root cause of why they are losing bone becomes known they can really help their situation and may not need drugs. It all depends. Finding out the root cause I’m told is best to work with a Functional/Integrative physician. And I would suggest getting a copy of Dr Keith McCormick’s book. And there’s a great place to learn all things about osteoporosis this upcoming week. Go to https://morebone health.byhealthmeans.com/?idev_id=30380. And if you don’t have time at least go to a podcast by Margie Bissinger put out on Jan 4 , 2024 with Craig . Title is something like - Osteoporosis 101 with Craig and Margie Bissinger. Good luck to you!!!!

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Thanks so much for this, @ans. You tapped on everything I'm attaching to, including this week's osteoporosis online seminar. What a service. Also I'm hearing great things about seeing a functional/integrative physician, but I don't know yet how to find one (is it a category in a provider directory?) or how insurance figures in. If anyone has any inside tips or knowledge, your input would be much appreciated!

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@dmalone20

My numbers are similar to yours and I’m not worrying about it unless I start to get fractures easily. I broke one bone my entire life and I’m 65! I do pretty intense strength training (trainer led with 6 women - most aged 40ish) and I started Osteostrong (heavy load). Once a week. Many women who go there (some traveling 2 hours to get there) have seen big improvements. I also take Algacal. I’ll retake my Dexascan (same place) in 2 years and see what happens. My OB/Gyn really put my mind at ease. The Osteoporosis doctor appt scared me like crazy and immediately suggested drugs. That’s ridiculous. IMO. That said, if a break a bone - just stepping off a curb - I’ll adjust my plan. Maybe.

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Thank you so much, @dmalone20. I completely relate to the "scary drug pushing appt", and I know we're not in the minority.

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@prettyflower

Thanks so much for this, @ans. You tapped on everything I'm attaching to, including this week's osteoporosis online seminar. What a service. Also I'm hearing great things about seeing a functional/integrative physician, but I don't know yet how to find one (is it a category in a provider directory?) or how insurance figures in. If anyone has any inside tips or knowledge, your input would be much appreciated!

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@prettyflower … well I’ll tell you you have to goggle to find who is in your area. I did that last year and let me tell you they are expensive and they don’t work with insurance . So you have to figure that all out on your own. My experience was the appts were months down the road. Because I had fractured already and most anyone was going to tell me I needed meds I decided to spend my money consulting with DrMcCormick instead. That’s not to say I might not do it someday, but I needed to get to the issue. I didn’t think waiting months to get in and then take more time to figure out my root causes was the way to go when I began down this road. You obviously are in a different position and that might very well be the best advise in your case. Glad to hear you’re on the summit , you will gain a ton of info!! Good luck!!

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