t-score merry-go-round

"Um, no thank you," Karyn, well done. you're no fool.
People with low bone loss also experience fragility fracture. Because TBS measures homogeneity in the spine,
that risk number would be interesting.
Minus 3.2 l-4 is your osteoporosis defining number.
While we are advised not to compare dxas on different types of machines, this difference is remarkable. The older dexa machines are less capable of eliminating increases in the accumulation of bone due to arthritis and bone spurs.
It will be interesting to see how this untangles.
I wish there were bone markers CTX and P1NP pre and post surgery. It would be interesing to see them now.
Hope your rheumatologist is thorough.

@gently Thank you, thank you for the helpful info! I hadn't known about the differences between old and new DXA machines.

What does osteoporosis defining number mean?

My BMD in the spine adjusted for TBS is -2.7.

I was thrilled when the new primary doc wanted bone marker tests. It wasn't until after completed (February) that I learned they both should be serum derived (not urine) and done fasting first thing in the morning. Dr didn't order as such, so I'm hoping the rheumatologist will re-order.

For reference, I fractured my T8 vertebrae with a T-score in the osteopenia range. In Feb 2023 it was -1.6 then I had a fracture in December 2023. In June 2024 I had another DEXA before starting anabolic therapy and it was -2.2. After Tymlos, teraparatide and a year of Evenity I am back to -1.5.

My fracture was caused by an ill advised movement: I bent over the edge of a bathtub and pressed down very hard on my rib cage trying to get my head under the faucet to rinse it. It was a bad combo of flexion plus pressure. I am much more careful now.

My point is that your T-score does mean a higher risk of fracture so pay attention to how you move.

@karyn23 osteoporosis is defined as -2,6 T score at any place measured.
We are also advised to avoid biotin and collagen several days before testing. Some sites advocate avoiding all B vitamins several days before the tests.
P1NP is more stable than CTX during 24 hours. I think it will be so interesting to see how much that has changed after surgery
If you decide to take medication for osteoporosis, I hope you keep saying no thanks to most of them. Take a close look at Forteo--my favorite.
Did you have more than one gland removed. How was your parathyroid issue diagnosed.

@gently

I SO appreciate all of this information! Will make sure to follow those protocols prior to bloodwork.

"osteoporosis is defined as -2,6 T score at any place measured." My understanding is that the average of the spine values must be taken. That is, the guidelines will not diagnose as osteoporosis on the basis of an individual vertebra. From what I've read, there must be at least 2 "readable" vertebrae, of which the average is taken.

My serum Ca and parathyroid hormones had been out of range a long while. A more recent nuclear test (sorry, can't recall the name) was suspicious for an adenoma. I had two glands removed.

Thanks for the heads-up re Forteo! Holding out on meds. A UCLA endo and another at Columbia both advise waiting a year after surgery before pharm intervention. I believe it's to see if the surgery turns the osteo around. The UCLA guy goes as far as to say that there may be evidence of bisphosphonates cancelling out benefits, if take that first year. A UCSD endo says otherwise - that it's okay to take meds the first year, harm won't occur. I think it's safe to say that osteo secondary to hyperparathyroidism doesn't manifest the same as primary osteoporosis . . . and they need more studies to figure out what's going on.

@oopsiedaisy Thank you for sharing this! I'm so sorry to hear about the fracture - it sounds like it was painful. So glad to hear that the meds have worked!!