What should I expect from my follow up DEXA?

There is some dissent about whether dxa should be done after the first year of bisphosphonates. The process is gradual since the drug works by accumulating bone. I would expect to maintain BMD, and not be discouraged if there were little change or even a slight lowering of BMD.. The rate of loss compared to prior years should improve. But that rate isn't calcuable without the prior years dxas. At three years you should expect gains.
Even so, I hope your gains are evident.
And I'm glad your medical provider is monitoring progress.

I’m in favor of annual DEXAs and I get annual DEXAs. For those who say you shouldn’t, this year I experienced the PERFECT reason for annual DEXAs. The GE Lunar scanner, which I had my last 3 DEXAs on, broke and is being replaced, so this year I had to go to a new imaging center and use a different machine. Ideally, DEXAs should be done on the same exact machine; otherwise, the comparison between DEXAs is “iffy”. By having DEXAs every year, next year, I’ll have an “accurate” comparison, if I’d waited 2 years between DEXAs, it would be years before I’d have data that could be compared.

Regarding what to expect on your next DEXA, the question I have is did your doctor do BTM (bone turnover marker) tests prior to your starting bisphosphonates? If s/he didn’t, just know most doctors, who claim to treat osteoporosis, fail to order these very important tests. If your doctor did order BTM tests for you prior to putting you on bisphosphonates, consider yourself extremely lucky.

BTM testing needs to be done prior to starting bone meds because you need a baseline. BTMs tell you if you are losing a lot of bone. Bisphosphonates do NOT build bone, they slow or reduce bone loss. So for ppl w/ low baseline BTM scores, there probably won’t be a big change between DEXAs, and hopefully there is little or no loss between DEXAs.

If your dr ordered the baseline BTM tests, you don’t need to wait for your next DEXA to see if the bisphoshonates are working. About 3 months after starting bisphosphonates, you can have your BTMs tested again and if the bisphosphonates are working your BTMs should be lower.

Hi and thank you for your reply.

Yes, my doctor ordered bone markers test before I started the meds and 2 months after that.
My baseline was bad... It showed that I was losing a lot of bone!
However. 2 months after that my beta crosslaps test showed a decrease in the rate of bone loss, So my doctor told me that it seems that the bisphosphonates are doing their job ! I was ellated 🙂
However, the follow-up DEXA will show what is really going on now. I hope that I can at least maintain my bone density, if not increase it

Thank you for your reply!

My bone markers were improved 2 months since the start of the medication, so that encourages me that there is hope 🙂

And I'm lucky that I have found such a great doctor. He never fails to explain everything to me and order every test that is needed.

Cool. Sounds like you may see nice results on your next DEXA.

Unfortunately, my doctor didn’t order BTM tests for me prior to prescribing bisphosphonates and I didn’t learn about BTMs until I had already started taking osteo-meds.

I didn’t see much improvement in my bones after taking bisphosphonates. I took alendronate for 1.5 yrs, took a 4 month holiday and then had one zoledronic acid infusion.

After learning about BTM testing, through my own research, I chose
not to have the 2nd dose of zoledronic acid that my endocrinologist had prescribed and instead, the day I would have been eligible for the 2nd dose, which was one yr after my 1st and only dose, I had BTM tests, at my request. My results showed that my BTMs were not elevated. Because bisphosphonates stay in one’s system for years, I can’t be certain that the bisphosphonates I’d taken previously hadn’t skewed my BTM results, but my gut feeling is, since my DEXAs didn’t show any significant gains, that my BTMs weren’t elevated when my endocrinologist prescribed the bisphosphonates and that I shouldn’t have taken them.

I recently had my 5th DEXA, and although it was done on a different scanner than my last DEXA, both scanners were GE Lunar and my results were very close to my last DEXA. I haven’t taken any osteo-meds since November 2021, and I eat a bone healthy diet and take supplements for my bones and I’ve been going to the gym 3 times a week since January 2021–I even went today 🙂

Last week I had BTM labs. I should get the results this week. Fingers-crossed my results show that my BTMs aren’t elevated.

That is really unfortunate that your doctor didn't order the bone markers. Since I have been diagnosed with osteoporosis, I have been reading scientific articles and expanding my knowlegde on this topic and as far as I can understand, bone markers are a really important measurement... Here where I live they are quite expensive tests if you do them on your own (I mean without being referred) but there is such an option as well. If my doctor didn't order them I would have paid out of my pocket... I think it is worth to know the results 🙂

Regarding the bisphosphonates. The first year after my initial DEXA (also after the diagnosis) I tried going the "natural route" but everything I got out from it were worse T-scores on my follow-up DEXA. And I'm in my 30s. So really really bad scores for my age. My doctor then prescribed the bisphosphonates.

Fingers crossed that your results are stellar! Good luck with everything 🙂