T-score variations

[haptalon]

I had a recent Dexa scan and am a bit confused by the results.

It shows that over 8 years, my T-score on my right hip neck has dropped from -2.1 to - 2.5 and yet my spine has increased from -0.8 to -0.1

Can anyone shed some light on this seeming disparity? Why have some bones become less dense whilst others more dense. FYI, I'm 72

[Met00]

Did you have the scans on the same machine? There are discrepancies between readings from different machines, but even if using the same one there's a margin of error, however well done it is. Arthritis in your spine or a healed fracture could give a higher reading, but any vertebrae affected this way should be onitted. , Add to that potential operator error.... However, having said all that, those are very good scores, only on the cusp of osteoporosis and below average loss of density for your hip, scarcely even osteopenia for your spine.

[haptalon in reply to Met00]

Thanks Met00. The scans were at the same hospital and the individual references etc seem to indicate it's still the same machine.

The Renal doctor wants me to either go on Adcal D3 or Alendronate depending whether my doctor determines me to have osteopenia or osteoporosis. Given that only one reading is at -2.5 then I would not want the Alendronate. However my Vitamin D and calcium levels are both fine so I'm not sure what good Adcal D3 would be.

[Met00 in reply to haptalon]

Have you had a fragility fracture or some other reason to be at high fracture risk? Otherwise I don't understand why you need meds. Make sure you get enough calcium in your diet. A vitamin D supplement is a good idea unless you have high Vit D blood levels, as this helps with calcium absorption, plus Vit K2 to help direct calcium to the bones. Eat healthily and get plenty of weight bearing exercise with impact.

[haptalon in reply to Met00]

Perhaps I should have said that as a kidney transplant patent, I am on steroids for life which of course reduces bone density - I'm only on a relatively low dose of 5mg prednisolone.

I have had breaks etc but not due to fragility - usually due to instability!

[Met00 in reply to haptalon]

It depends whether the fractures happened unexpectedly, eg just falling from standing height - fragility fractures, without impact, that wouldn't happen to someone with normal bone density. That is a significant factor in determining whether medication is recommended. If you've fallen over and broken a wrist, for example, then there's a good chance you'll have more fractures and the medication aims to reduce the risk of these. Opinion, however, is divided over how effective the medication is. Also bear in mind that 19% risk of fracture (probably calculated for the next 10 years) is still 81% chance of not fracturing. It depends how you view risk, and what you think of the medication.

[haptalon in reply to Met00]

Thanks Met00. Any fractures I've had have been bad falls etc. I've had many more falls without fractures so I feel pretty certain that historically no fractures have been due to low b bone density

[Mark_ABH in reply to haptalon]

Hi Haptalon, long-term use of prednisone is indeed associated with increased risk of fractures.

We invite you to take an assessment via the American Bone Health Fracture Risk Calculator. By entering all your various medical conditions and medications etc., you'll get a fuller picture of your fracture risk. Bone density score is only one factor -- and often not the most important factor. americanbonehealth.org/calc...

[yogalibrarian]

Do you have arthritis in your spine? That can sometimes skew the readings and make the bones appear more dense.

Also, wasa the scan done on the same machine by the same technician. Not getting the proper alignment and the exact same frame will change the results. (A certified densiometrist is skilled at getting the right placement. Not all techncians have those credentials.)

[haptalon in reply to yogalibrarian]

Thanks yogolibrarian..please see my reply to Met00

[yogalibrarian in reply to haptalon]

If you've had spinal fractures, they could also contribute to an inaccurate result.

If you are on immunosuppressants for the kidney transplant, those -- along with the steroids -- could contribute to bone loss.

Have you done the Fracture Risk Assessment?

Has your doctor done other tests to look at bone turnover?

[haptalon in reply to yogalibrarian]

Hi yogolibrarian

No spinal fractures and I am on immunosupressants

They show 10 year fracture risks as: Major Osteoporotic Fracture 19% and Hip fracture 7.3%. These compare to the levels 7 years ago of 13% and 4.6% respectively.

No one has mentioned anything about bone turnover.