Fragility score on Osteoscan and different meds.

[Nightingales]

Hello to “my turn to” friends. This is a new one to me.I had an osteoscan, my second. The last one was nearly two years ago. Since then I have had a Thr for Avascular necrosis and I am still struggling along dealing with flares after eight years. I have been on Leflunomide for two months now. Tapering 1 mg month down to 13, no flare as yet. This is my letter re the scan.

“It was a pleasure to see you today and to be able to offer a further REMS evaluation of your right hip and spine.

The bone density at both sites has dropped a little which is partly due to age and partly due to the steroids. However, you remain osteopenic not osteoporotic at both sites.

As we discussed this does not reflect your true fracture risk which the Fragility Score indicates is high at both sites (see Paola Pisani's paper).

As a result I think an anti-resorptive drug is less appropriate for you than an anabolic drug (e.g., teriparatide, abaloparatide or Romosozumab) as shown in the paper attached from Ego Seeman's group in Australia in 2018.

You might want to discuss with Dr Nandi the relative merits of anabolic drugs given your recent history of avascular necrosis”.

Kind regards

Nick

Nick Birch FRCS (Orth)

Consultant Spine and Bone Health Specialist

I did send my scan and this letter to my rheumatologist who instructed me to get referred to an osteoporosis clinic run by a different Dr. He said he would talk to this Dr on their return from various holidays. My rheumatologist doesn’t like being questioned, has been stuck on nagging me about osteoporosis meds for years, which I have so far refused apart from hrt. Of course the referral may take months. I can’t get into the GP for a month.

I apologise if these links done work. I have them in pdf and can’t figure out how to share them.

link.springer.com/article/1...

2023 Pisani - Fragility Score_ a REMS-based indicator for the prediction of incident fragility fractures at 5 years.pdf

frontiersin.org/articles/10...

Have you come across these meds before? Any advice or opinions gratefully received.



[PMRpro Ambassador]

"Teriparatide and abaloparatide are parathyroid hormone receptor agonists that increase bone remodeling with bone formation increasing more than bone resorption. Romosozumab is a humanized monoclonal antibody to sclerostin that has a “dual effect” of increasing bone formation while decreasing bone resorption."

i.e. they all actively BUILD bone rather than just stopping density falling so it doesn't get worse.

Teriparatide is sold under the name of Forteo and I think is used on the NHS, not sure about the other two.

I suggest you call the ROS helpline as they are the most likely source of info - your GP won't be much use I suspect.

theros.org.uk/

PS - your links work

[Nightingales in reply to PMRpro]

Thank you! I thought it was an interesting twist because as far as I know the Dexa Scan doesn’t measure fragility. I had called the ROS in the past and they have been very helpful. I am hoping I can get into see this new Dr who runs the osteoarthritis clinic as he has good reviews. Could you tell me, if I post here will it be seen in the osteoporosis group as well as PMR?

[PMRpro Ambassador in reply to Nightingales]

No, they are separate and you have to post for both, Just copy and paste, you don't have to write it all out again. Are you a member over there?

[Nightingales in reply to PMRpro]

Yes I am. Thanks.