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Looking for a TBS (trabecular bone score) expert.

FearFracture profile image
53 Replies

Please reply if you have any experience/knowledge you can share about TBS (trabecular bone scores). Note, I recently had a DEXA w/ TBS and I trying to better understand my results and hear what others think.

53 Replies
Mahler02 profile image
Mahler02

My spine TBS was in the red zone but my Frax was low back in March and my rheumatologist did not want to put me on medication. I ended up fracturing L1 in November. I think it’s important info for medication decisions and should help you avoid a fracture, which can be life changing.

FearFracture profile image
FearFracture in reply to Mahler02

Do you know your exact trabecular bone scores? Were the scores for all 4 vertebrae in the red, meaning were they all showing degraded?

On my report it shows my TBS results L1 - L4 = 1.287 (partially degraded microarchitecture) so that is the average of all 4 lumbar vertebrae.

Normal microarchitecture > 1.31

Degraded < or = 1.23.

Given that my 1.287 is closer to 1.31 than 1.23 I took that as an awesome sign. Now, here's where I question my TBS results. On page one of the report, there is an image of my L1 - L4 called TBS Mapping and the colors are green (high TBS), yellow is in the middle, and red (low TBS) so the image of my spine, or TBS Mapping, shows each vertebrae shaded in these colors to show what my trabecular bone looks like. On page two, there is a chart labeled "Detailed Spine Results" and it lists the TBS for each vertebrae.

L1 = 1.278 TBS

L2 = 1.323 TBS

L3 = 1.342 TBS

L4 = 1.205 TBS

L1 - L4 = 1.287 TBS (the average)

My TBS scores for L2 and L3 both are in the normal range because they are both above 1.31. Additionally L1, which is 1.278 shows as partially degraded; however, according to the report that I received my L4 is 1.205 or degraded. 

My gut feeling is that the TBS they listed for my L4 is wrong. From everything I have read about DEXAs and bone density, generally speaking, unless there is an identifiable reason, such as cancer or a hurt or broken bone, t-scores are somewhat in alignment in certain areas of the body. Unless there is a cause/reason, it would be usual for someone to have a LEFT hip t-score of -5 and a RIGHT hip t-score of -1, and you won't usually see people with extreme differences between their total lumbar t-score and their hip t-scores. Additionally, the TBS Mapping image on the first page of the report, shows that my spine is slightly curved, this shows up a little in L3 and more in L4. In this mapping image they have rectangles or blocks around each vertebrae, and the L4 block is bigger than any of the other blocks because of the curve in my spine and because of this there is a good amount of blank space captured, which I believe may be skewing my L4 TBS.

Lani Simpson, lanisimpson.com/ talks a lot about how most ppl (doctors, radiologists, technicians) have no idea what they are doing when it comes to DEXA scans and they make mistakes because of this. Ex. When I told the technician who did my DEXA w/ TBS that there was a difference of .5 in my t-scores, she made the comment, "A 1/2 pt is nothing." She apparently doesn’t know that a .5 difference in t-scores is not a 1/2 point, it's half of one standard deviation, which, when it comes to bone density, is HUGE.

Mahler02 profile image
Mahler02 in reply to FearFracture

My TBS differed for each vertebra and was lowest for the vertebra I fractured, vs my BMD which was borderline. I would definitely be celebrating with your scores. It sounds like your BMD is a bit skewed due to being petite.

Raleigh59 profile image
Raleigh59 in reply to FearFracture

what country are you in? I have my dexa report and it’s not written like that.

FearFracture profile image
FearFracture in reply to Raleigh59

I’m in the US. Unless you are the exception to the rule, you had a standard DEXA scan. The numbers I have posted above are my TBS (trabecular bone scores) numbers. Most imaging center don’t have TBS capabilities.

Also, many imaging centers only give patients a DEXA summary. That’s what happened to me after my July 2019 and July 2021 DEXAs. It wasn’t until around January 2022, that I learned that I’d never been given my full DEXA reports. Although you most likely did not have a DEXA w/ TBS, meaning there won’t be trabecular bone scores on your DEXA report, you should still make sure you were given your full DEXA report.

Your user id is Raleigh59. If that Raleigh is an indication of where you live, meaning NC, you are in luck. I emailed Echolight last year and there is an imaging center, not far from Raleigh, that has an REM scanner. Let me know if you want the information.

Raleigh59 profile image
Raleigh59 in reply to FearFracture

yea I want the info thanks.

FearFracture profile image
FearFracture in reply to Raleigh59

Dr Andy Bush ( Orthopedic Surgeon)  Central Carolina Orthopaedic Associates  Sanford, NC  

919-774-1355

DEXA scans are covered by health insurance. REM scans are not. When I spoke to Central Carolina Orthopedic Associates in the fall of 2022, I think they said the cost of the scan itself was $75. I was willing to drive to NC and pay the $75, but, because my insurance doesn’t cover out of state care, I would have also had to pay approximately $600 for consultations w/ the doctor. If you are in NC or if your insurance covers out of state costs, you shouldn’t run into this issue, meaning the consultations might be cover by your insurance.

Echolight is the company that sells REM scanners. If you’ve read any posts submitted by Europeans you may have noticed they often refer to REM scans.

Echolight opened U.S. headquarters not too long ago and currently there are about a dozen REM scanners in the US. I’m hoping in the near future an imaging center in my state gets an REM scanner. I would have opted for the REM scan over the DEXA w/ TBS but since the DEXA w/ TBS was covered by my insurance and the out of state REM scan was not, I opted for the DEXA w/ TBS.

If you are serious about getting the REM scan, I suggest getting it done prior to you endocrinologist appt, if possible, but don’t be surprised if your doctor is unfamiliar with REM scans.

Raleigh59 profile image
Raleigh59 in reply to FearFracture

I didn’t know to get dexa with TBS so I don’t have those scores and I was given the full report. Are you the person who takes the ancestral living bone ? Do you still take strontium ?

FearFracture profile image
FearFracture in reply to Raleigh59

To answer your questions no and no. Everything I’ve read indicates that strontium is a bad idea 👎🏻 and I do not take it. Most ppl do not get DEXAS w/ TBS because most DEXA scanners do not have the software necessary to do a DEXA w/ TBS and most doctors are clueless about DEXA w/ TBS.

I sent the link below about REM scanners in case you decide to schedule an appt at the imaging center in Sanford that has an REM scanner. Read the info (post) in that link.

Raleigh59 profile image
Raleigh59 in reply to FearFracture

yes I am calling the rems center tomorrow. I have an appt with endocrinologist in March so maybe a rems report would be better. I have read mixed reports on strontium.

Raleigh59 profile image
Raleigh59 in reply to FearFracture

can you be specific why strontium is bad . I’ve rad it helps strengthen your bones and to take it every evening . I know people say it masks the dexa scores

FearFracture profile image
FearFracture in reply to Raleigh59

The experts are against taking strontium americanbonehealth.org/medi...

If you have the REM scan, please remember to come back and post your results and what you learn.

Raleigh59 profile image
Raleigh59 in reply to FearFracture

the rems is $75 and the doctor parts are not covered by my insurance and add up to $600+ .

his initial video appt alone is $225. I told her if there is a clinical trial or other discount to call me.

FearFracture profile image
FearFracture in reply to Raleigh59

Also, just found this on HealthUnlocked. You may find it interesting.

healthunlocked.com/american...

Raleigh59 profile image
Raleigh59 in reply to FearFracture

that gave me hope . I just ordered ancestral living bone and bone armour

FearFracture profile image
FearFracture in reply to Raleigh59

I’m not familiar w/ ancestral living bone and bone armour, but I recently started taking Jarrows Bone Up because it contains calcium microcrystalline hydroxyapatite. I looked up ancestral living bone and it also contains calcium microcrystalline hydroxyapatite.

Raleigh59 profile image
Raleigh59 in reply to FearFracture

how many do you take per day

FearFracture profile image
FearFracture in reply to Raleigh59

I recently downloaded Cronometer and am closely tracking my diet (vitamins and minerals). Generally, I’m getting anywhere from 600 to 1000 mg of calcium from my diet so I take supplements accordingly. The Jarrows Bone Up that I’m using has approximately 166 mg of calcium per pill. It also contains several other vitamins and minerals. I’m trying to hit my numbers on vitamins and minerals and not get excessive amnts so I take one Jarrows Bone Up tablet and use generic calcium citrate petite (200 mg) supplements to make up the difference to make sure I get between 1200-1500 of calcium per day. 

Raleigh59 profile image
Raleigh59 in reply to FearFracture

I am going to start adding up my calcium from food and supplements each day .

Raleigh59 profile image
Raleigh59 in reply to FearFracture

I agree that the microcrystalline hydroxyapatite is very important

trabeculae profile image
trabeculae in reply to FearFracture

Hi, Fear Fracture - I've been AWOL (life🤦‍♀️). I would love to have TBS scores like yours. Mine are all degraded. I know I have a lot of degenerative stuff in my low back - so my higher BMD in my L4 may be because of that (arthritic bone spurs/degeneration can cause falsely elevated BMDs). For me, the L-spine averages are important. My TBS scores all are barely above 1.0. 😞 I am a perfect example of why DEXA w/TBS is important. My BMD T-scores are osteopenic (better than -2.5 including both hips & femoral necks) - but my TBS T-scores are all -4s to -5s - which likely is how I ended up with multiple fragility fractures in a short time.

FearFracture profile image
FearFracture

I'm guessing you took a look at my bio and saw the link to the post with my DEXA scan results. I know my bone density probably isn't perfect but I do think there is a decent chance that my small size is making my numbers appear worse than they actually are.

When you say "TBS differed for each vertebra and was lowest for the vertebra I fractured" how big was the difference between vertebra?

According to my TBS scan L3 = 1.342 TBS and L4 = 1.205 TBS so L3 is in the "normal" range and L4 is in the degraded range and the difference between those 2 vertebra is .137. This seems like a large difference and per the TBS report, my L4 TBS seems to be the outlier

I really wish I could find a qualified doctor/expert who coould help me interpret or better understand my bone turnover marker blood work and my DEXAs and TBS. Someone who could also make sure there aren't any other tests that are missing that should be done. My current endocrinologist is only good for one thing, writing prescriptions. He has know ideas except, take meds. The bone turnover marker tests were my idea, the TBS was my idea (he didn't even know where I could get a TBS, I had to hunt for that on my own), and I'm really sick of paying to see him when I'm doing all the work.

In 2017, I was mistakenly given an MRI for my lower back. How can someone mistakenly be given an MRI for her lower back you ask. Well, I was (and still am) experiencing a strange burning sensation in the middle of my back, right about were a bra-strap would hook. My, then, primary care physician (PCP), ordered and MRI. I went in and had the MRI done, turns out she ordered an MRI of my lumbar spine not my thoracic spine--I have NEVER had lower back pain, I did NOT tell my PCP that I had lower back pain, I was very CLEAR about the issue being the center of my back. My reason for bring this up is that my 1st DEXA was in 2019 and that is when I was diagnosed with osteoporosis. My total lumbar spine T-score was -3.9. There is no way I went from perfect bones to -3.9 in 2 years (meaning between 2017 when I had the MRI and 2019 when I had my 1st DEXA). Bone loss shows up on MRIs and my PCP didn't order a DEXA after getting the results of the MRI. I would like to find someone who could take a look at the MRI scans and tell me what my bones looked like in 2017 too.

Raleigh59 profile image
Raleigh59 in reply to FearFracture

the Mayo Clinic has second opinions through video calls

FearFracture profile image
FearFracture in reply to Raleigh59

Thank you. I just looked up Mayo Clinic second opinions and have scanned over some info on their website but the one thing I’m not seeing is the cost. Do you have any idea what they charge for this service?

trabeculae profile image
trabeculae in reply to FearFracture

An orthopedic doctor should be able to review MRI images and tell you more. They also could order an MRI of your T-spine if they feel it is indicated. Both as an RN & a patient, I've found the only providers who primarily look at images tend to be emergency dept, neuro or ortho providers (the others look at the reports).

Mahler02 profile image
Mahler02

I would suggest a video consultation with one of the OP thought leaders, Dr. Stuart Silverman (drstuartsilverman.com/) in Los Angeles or Dr. Paul Miller in Colorado (millerbonecenter.com/)!

FearFracture profile image
FearFracture

Thanks. The first link didn't work, but I can look him up via search and I was able to access the second link. If money were not a factor, I would reachout to one of those doctors and/or a few other experts that I have found on the web, for ex. Dr. Brown at BetterBones.com and Dr. Lani Simpson, but none of them consult for free and usually the prices are a bit high--I'm sure they are worth it and if I win the Lotto LOL I will spend whatever it takes.

I just paid out of pocket for a DEXA because insurance won't cover two DEXAs in less than 12 months and I wanted the DEXA w/ TBS, which was done on a Hologic scanner because it was practically the only place in the state that I could get it done, and I needed a DEXA on the same GE Lunar scanner I'd used for my previous 2 scans so the data could be easily compared. I also purchased minimalist shoes--studies show that wearing minimalist shoes is as effective as doing foot exercises for stengthening feet. I decided to buy them because it saves me time by not having to do foot and ankle exercises. That might sound silly but I spend at least 4.5 to 6 hours at the gym each week (and pay for monthly membership) and I walk once or twice a day, so that's another 20 to 40 minutes daily, and I do heal drops most mornings and push-ups at least 3 times a week, so saving time not having to do another set of foot specific exercises makes sense to me.

Staying healthy is time consuming and costly :-)

I tried finding a new endocrinologist last year, and although my insurance doesn't require that I get a referral to see a specialist, the endocrinologists in my city require a referral to get an appt. After going to all the trouble, I didn't like the doctor I got the referral to so I haven't been back to see her. There is one more endocrinologist on my insurance plan that I will try to get a referral to but when I was looking for a new endocrinologist last year, this particular doctors schedule was book for like 9 months out.

I'm thinking about asking my PCP who the best in-state endocrinologists are. If any of them are covered by my insurance, I could make an appt and if need be just plan on an overnight trip.

I'm currently watching youtube.com/watch?v=cz3f6LD... and the presenter just said that the honeycomb bone (meaning trabecular bone) is the type of bone most effected by menopause and aging (if you want to hear this portion of the talk just go to 11:45 in the video recording). My endocrinologist assumed that my bone loss was caused by my early menopause, I think that my hypothyriodism may have had a good deal to do with my BMD being low.

Side note: I have the phone number to the technician who services the GE Lunar DEXA scanner that was used for my 2019, 2021, and 2022 scans--why I have his number is a long story but the short version is that I called GE to ask a question and he called me back :-) I'm thinking about reaching out to him to get him to try to persuade the imagining center to purchase/install the TBS software so, when I have my DEXA in December 2023, I would be able to get the TBS numbers on my normal scanner.

Mahler02 profile image
Mahler02 in reply to FearFracture

TBS DD. 03/09/2022 NB lowest score L1 (where I fractured):

LI 0.961

L2 0.984

L3 1.124

L4 1.255

I am very comfortable going on Tymlos with these scores. Just an NB but my BMD appears to be stable and may have improved in my hips but I had to switch machines from Lunar to Hologic and then use an algorithm to make scores (2021, 2023) somewhat comparable (see courses.washington.edu/bone.... Improvement in spine beyond margin of error probably skewed by L1 fracture. Improvement in hips above margin of error more likely. For what it's worth, after the DEXA in 2021 indicated OP, I radically changed my diet, exercise, supplements knowing that as a postmenopausal person it would be hard to improve my scores. I also use the Marodyne LiV platform daily.

FearFracture profile image
FearFracture in reply to Mahler02

Thanks for the link. I'm familiar with Dr. Susan Ott's BMAD calculator courses.washington.edu/bone... I will now take the time to go through the entire site and see if I can "pick up" anything. With your TBS scores it's weird that your doctor didn't want to prescribe meds. From everything I've read, TBS is "more important" than BMD in terms of actual bone quality.

One reason I requested the DEXA w/ TBS is after doing my research, I was convinced that it needed to be considered. My endocrinologist prescribed bisphosphonates totally based on my 2019 DEXA summary. He didn't run any tests to see what was going on & he didn't bother to look at my full DEXA report.

I see what you mean about there being a difference in your TBS numbers. Between your highest score in L4 and lowest score L1 the difference is .294. If you look at my highest L3 and lowest L4, the difference is .135 so maybe my L4 score is correct but I still question the image in the TBS mapping thats show each vertebra, meaning I still think they may have captured area that should not have been included in the analysis of L4 and potentially that skewed my score.

One thing I noticed about your scores is they get progressively better. L1 was the lowest, then L2, then L3 & L4 had the highest TBS. On my scan, L3 has the highest TBS & L4 has the lowest & that seems odd.

I understand your choice to take Tymlos--it can actually "grow" bone & repair your trabecular bone. This was another reason I wanted a DEXA w/ TBS done. Once I got my hands on my full DEXA reports for '19 & '21, I could see that my endocrinologist had based his reason for prescribing a zoledronic acid infusion on faulty assumptions because he never looked at my full reports. He said the alendronate had improved my left hip by approximately 10%. It had not. My 2019 DEXA is obvioulsy wrong.

The reason my endocrinologist started w/ bisphosphonates--why he started me on alendronate in '20--or so he said, is that he thinks there is not enough long-term info on newer drugs (Prolia, Evenity) & bisphosphonates have been around longer & his thought was, since I was only 51 at the time, I could be on bisphosphonates a few years then stop & then, who knows what else would be available 10 or 20 years from now.

From all I have read, if you take bisphosphonates before anabolics, the bisphosphonates reduce the effectiveness of the anabolics. Additionally, I don't know if this is the case with anabolics, but with Prolia, once you stop you have to take bisphosphonates to prevent rebound fractures. If you can only take bisphosphonates for a couple of years, if I take them now, what option would be available to me if I were to take an osteomed that requires that I take bisphosphonates after quitting that med.

Until I can get a better understanding of my test results, I don't want to take anything else. However, I am considering trying HRT. I don't know if it will work, but many women see improvements in their BMD when on HRT. I believe it was in one of Dr. Brown's (BetterBones.com) books that I read about a study showing that women on HRT who took magnesium improved their trabecular bone scores & according to pubmed.ncbi.nlm.nih.gov/827... postmenopausal women "received two to six tablets daily of 125 mg each of magnesium hydroxide" .... "Twenty-two patients (71 per cent) responded by a 1-8 per cent rise of bone density. The mean bone density of all treated patients increased significantly after 1 year (P 0.05). The mean bone density of the responders increased significantly both after one year (P < 0.001) and after 2 years (P < 0.02)." I added magnesium to my daily supplements in late May 2022 & currently take 200 mg of magnesium citrate daily.

You commented, "For what it's worth, after the DEXA in 2021 indicated OP, I radically changed my diet, exercise, supplements knowing that as a postmenopausal person it would be hard to improve my scores." I didn't start making changes to my diet, supplements and exercise program until late 2021, early 2022, almost 2.5 years after my 1st DEXA because I really didn't understand how bad my number were until November 2021, when some random telehealth doctor explained my DEXAs to me. After that I had the zoledronic acid infusion my endocrinologist had been pushing because I didn't know what else to do and then I started doing my own research & in 2022, I upped my game: joined a gym, changed my diet and supplements, started eating prunes every day, worked on my sleep habits, etc.

Going back to the DEXA w/ TBS on the Hologic scanner that I had the 1st week in December '22, I haven't received the full report yet but a day or 2 after having the scan, they posted the summary in the patient portal. The summary didn't include the TBS data (which was the entire reason I drove 5 hours to use their machine) & the summary showed that my T-Scores were lower than my July 2021 GE Lunar DEXA T-Scores. That was a really rough day. I was so disappointed.

Here are the #s from the 2 different machines. The scan were done 1 week apart.

Hologic Scanner - 1st week in December

Lumbar spine -4.0

Left femoral neck -3.3

Total left femur -2.6

Left one third radius -2.3

GE Lunar Scanner - 2nd week in December

Lumbar spine -3.6

Left femoral neck -3.1

Total left femur -3.0

Left one third radius - n/a

I don't know why the t-score vary so greatly. It was my understanding that the even though the BMD would be different between the 2 machines that that t-score should be similiar. I know that even on the same machine the numbers can be different on 2 scans done a week apart but -4.0 vs. -3.6 seem like a big swing and on the Hologic scan when I received the TBS report the list t-score adjusted (adjusted for ethnicity, gender and TBS) and it lists

BMD T-scores adjusted

Lumbar spine -4.8

Left femoral neck -3.6

Total left femur -3.0

My short term goals are to obtain a copy of my full Hologic DEXA report including the ancillary data & to set up a telehealth appt to see if I can find some random Dr. to explain my bone turnover marker tests. All my endocrinologist had to say about the 4 tests done was that my Osteocalcin was low. It was 8.8. The bone turnover marker pdf (posted in my bio) says that bisphosphonates lower osteocalcin so if it's too low why would he want me to have another zoledronic acid infusion? Also, I have hypothyroidism & that can cause osteocalcin to be low--my endocrinologist treats my hypothyriodism should know this. I was researching osteocalcin last night & something I found said that if osteocalcin blood work isn't kept at low temps the tests will be wrong, or something like that, additionally, I found a study that showed that postmenopausal women who exercised were able to increase their osteocalcin--I walk most days & go to the gym every other day so!?!?!?

trabeculae profile image
trabeculae in reply to FearFracture

TBS software (I've been told by 2 providers) is very expensive. I think that is why I so far in my area have only found it used by a teaching medical center where I go yearly and an osteoporosis clinic where I go for my scans. Let us know if your GE guy convinces your imaging center to get TBS. That would be a huge win!

FearFracture profile image
FearFracture in reply to trabeculae

I will definitely report back!

On another note, I’m in a spread the news mood and if you are interested there is a free On-line Osteoporosis Forum March 27 - April 2, 2023.

morebonehealth.byhealthmean...

yogalibrarian profile image
yogalibrarianModerator

Of course, you should be asking your healthcare provider... But we know that they often don't have time for full explanations.

Dr. Lynn Kohlmeier did an excellent presentation at RSNA 2022. I can't find the link to the video at the moment, but here is a link to the slides. (It answered many of my questions.)

slideshare.net/ssuser4eaa71...

medimapsgroup.com/rethinkin...

One important thing to remember is that TBS, DXA, bone marker tests, etc. are clinical tools designed to be used by clinicians. They are pieces of a very complex puzzle. Together with the healthcare provider's expertise, they help create a diagnosis and treatment plan.

Understanding something about them will help you have a productive conversation with your healthcare provider.

FearFracture profile image
FearFracture in reply to yogalibrarian

Thank you. I will check out those links.

My endocrinologist is good at writing prescriptions but he has no time to answer any of my questions. My DEXA w/ TBS and my bone turnover marker labs were only ordered because I learned about these things when doing my own research on osteoporosis and I then asked about having them done.

When I called the manufacturer of zoledronic acid, the drug my endocrinologist prescribed, to get more information because my endocrinologist was unable to answer some of my questions about zoledronic acid, the company told me my doctor could call them for a peer-to-peer discussion and then he could relay the answers to me. I mentioned this to my endocrinologist and he said, “I don’t have time for that.”

My endocrinologist has never bothered to get full copies of my DEXA reports. He bases his recommendations solely on the summaries, which, after doing my own research and learning I had never been given my full reports (I didn’t know the summary wasn’t the full report) and having to spend months getting access to my full reports, I now know it is irresponsible for a doctor not to look at the full DEXA report. During my last appt in mid-December, I showed up with a CD that had my most recent full DEXA report on it. I told my endocrinologist that he could make a copy of it, and he said he didn’t have time for that.

Yes, I agree doctors should answer patients questions but my endocrinologist leaves a lot to be desired.

During my last gastroenterologist visit, when I asked Dr. M about a previous procedure done by a different doctor, he asked me to give him a minute and he left the room, went and looked up my records and came back with the answer. Dr. M is the best. More doctors should be like him.

I’m currently trying to find a new endocrinologist, it’s not a simple process, and I’m considering trying to Teladoc some of my questions. My insurance covers telehealth and it was actually a telehealth doctor who explained my DEXA scan to me. I took stats in college, it’s been a long time 30+ years so the term t-score was long forgotten but standard deviation that I clearly remember. For my endocrinologist to let me leave his office with just your lumbar spine t-score is -3.9 and your bones are “horrible” WOW. 2 years later a random telehealth doctor final explained that means my bones are approximately 40% less dense than an average 30 year old.

Cat551 profile image
Cat551

I had a Dexa scan and my Spine specifically L3 and L4 respectively were -3.3 and -3.5. I had a REMS or Echolight scan about 2 months later and my L3 and L4 were in the osteopenia range. The physician explained that DEXA calculates using bone surface. I had a laminectomy on L4 about 10 years ago and they removed bone. Therefore, my bone surface is reduced. The DEXA doesn’t allow for those kinds of outliers. My fragility score with REMS was in the green zone, meaning low risk of fracture. That gave me a little peace of mind. Even though, I’m considering going on Forteo. I’ve researched and tried many natural methods. My concern is that with every year bone density falls. I want to get back to osteopenia, so I feel strong enough, and it’s safe enough to use weights. A friend of mine reversed osteoporosis in her hips with weights, with a certified instructor. I’m don’t think it’s safe to use over 10 lbs with osteoporosis of the spine.

FearFracture profile image
FearFracture in reply to Cat551

Thanks for sharing this. I looked in to having an REM scan but there isn’t an imaging center in my state that has one. The closest one is 2 states away about a 5-6 hour drive. I called the facility and the cost of the REM scan is around $75 and insurance will not cover it. I would plan a trip, pay the $75 and get the REM scan but, unfortunately, I would have to pay another $600ish to see a doctor in that state and get the referral. If I lived in that state the $600 would be covered by hlth ins. My insurance doesn’t cover out of state treatments, and $675 + the expense of the trip, well, it’s a bit more than I can swing at this time. I’m hoping that in the next couple of yrs a facility in my state will get an REM scanner.

I understand your concerns about BMD declining as the yrs go by. I, too, feel like I’m working against the clock.

Because of the pandemic, I wasn’t able to join a gym until 2022, but I’ve been going for over a year now and I’m happy with my progress. I was really concerned about what I could and couldn’t do weight-wise and the doctors I asked had no real advice. I did start with lower weights and I mostly use the weight machines (not free weights). Between my July 2021 DEXA and my December 2022 DEXA my lean body mass increased.

My endocrinologist ordered another zoledronic acid infusion for me for November 2022 but I opted not to have it. In addition to osteoporosis I have hypothyroidism and I really question if the bisphosphonates are actually doing anything. Right now, I’m considering HRT. It’s been decades since I went through menopause (I’m 54 now but went through a premature menopause) and all my doctors told me that it was too late for me to do HRT. Then, on this site, I noticed a good number of women posting that HRT helped improve their BMD so when I saw my new OB/GYN PA last fall, I asked her about starting HRT and she said she would prescribe it. Honestly, it seems like it’s worth a shot. Like bisphosphonates, HRT is supposed to reduce bone turnover and in my opinion the potential side effects from HRT are better than the potential side effects from bisphosphonates. HRT seems like a more “natural” approach.

Cat551 profile image
Cat551

I live in Ga and drove to N. Carolina, a 7 hour drive. No referral needed and the dr. there called me at home and interpreted the results. I went home with the scan printouts and interpretations. The whole thing was $60 (plus accommodations, we stayed over and drove home in the am).

FearFracture profile image
FearFracture in reply to Cat551

Interesting. The imaging facility I contacted is in NC. They told me they used to charge $60 for the scan but had increased it to $75.

Is this where you went/who you saw?

Dr Andy Bush ( Orthopedic Surgeon)  Central Carolina Orthopaedic Associates  Sanford, NC  919-774-1355 

That’s who I called.

Cat551 profile image
Cat551 in reply to FearFracture

Yes, that’s it. Dr. Bush is immersed in the REMS method. When he called we talked for over an hour. He really gets into it. Recently, I sent him some questions and he called me again and we talked over an hour. He’s not real big on medication if your fragility scores are good. He doesn’t discourage it though. I decided on medication now, knowing I’d probably have to go on it sooner or later.

FearFracture profile image
FearFracture in reply to Cat551

I wonder how you lucked out and only got charged $60. Are you sure your consultation with him wasn’t covered by your insurance?

Raleigh59 profile image
Raleigh59 in reply to Cat551

Dr. Bush is not covered by my insurance nor is the scan . He does not take every insurance.

Raleigh59 profile image
Raleigh59 in reply to Cat551

Hi Cat- which rem scan place did you go to ? I am in nc and want to go to the one you went to.

Cat551 profile image
Cat551 in reply to Raleigh59

Central Carolina Orthopaedics Associates PO Box 3247 Sanford, NC 27331-3247

Office: 919-774-1355

Raleigh59 profile image
Raleigh59 in reply to Cat551

I called them yesterday and it’s not covered by my insurance. I am just going to buckle down on weight bearing classes and I might do osteostrong or buy a vibration plate.

Raleigh59 profile image
Raleigh59 in reply to Cat551

HRT has cancer risks

FearFracture profile image
FearFracture in reply to Raleigh59

The risks are low and it depends on form taken. Bio-identical in a patch form is low risk. In England they seem to be willing to prescribe it to woman of any age.

One of the problems with “risk of X” when taking is that it’s impossible for studies to eliminate other behaviors that also increased the risk of X. For example, diet, alcohol, stress, physical activity, smoking. So unless the studies included only women who don’t smoke and don’t drink and eat hlthy diets and exercise, there is no way to say the it was just the HRT that led to the development of breast cancer.

Raleigh59 profile image
Raleigh59 in reply to FearFracture

this forum in general is pro exercise and it seems unless people do an hour every day of weight lifting exercise which would include yoga they won’t improve their bone density

FearFracture profile image
FearFracture in reply to Raleigh59

I’ve always read/heard that every other day is good. Your body/muscles need time to rest and repair between weightlifting sessions.

I do try to exercise every day. I walk 6-7 day a week and go to the gym 3 times a week for about an hour.

Every once in a while, I skip walking but this is usually do to bad weather or I don’t feel well or I had a million things to do one day and couldn’t find the time.

I also toss in random exercises at home every now and then: squats, lunges, pushups, sprinting across my back yard, balancing, etc.

Raleigh59 profile image
Raleigh59 in reply to FearFracture

we will all take on our own risks

FearFracture profile image
FearFracture in reply to Raleigh59

Last year, I signed up for this on-line osteoporosis forum. Lots of info. morebonehealth.byhealthmean...

Raleigh59 profile image
Raleigh59 in reply to FearFracture

thank you fearfracture 🙂

Raleigh59 profile image
Raleigh59 in reply to FearFracture

side effects of bioidenticle hormones

Side effects of bioidentical hormones
Cat551 profile image
Cat551

Maybe the consultation was covered by my insurance now that I think about it. It was last summer. I have Medicare and a supplement that must have paid that. I didn’t get a bill, only paid the $60.

FearFracture profile image
FearFracture

I might see if I can get an appt with an orthopedist to get him/her to look at my lower back MRI to see what they think.

I’m still trying to get my Full DEXA report to including the ancillary data from the facility that did my DEXA w/ TBS in early December 2022. I’ve called multiple times and no response me helps or gets back to me and when I called in early February the person I spoke to said I needed to submit a request via the form on their website so I did. Last week they sent me an email that contained 12 pages which included a picture of my ID, the forms I filled out before having the scan, the DEXA referral I faxed to them and NOTHING related to my DEXA w/ TBS scan. I called again on Friday. HIPPA requires they provide my hlth info. If I don’t get the full report and ancillary data soon I’m reporting them. I can’t continue to beg for info that should be easy for these so called “health professionals” to provide. It’s exhausting and time consuming.

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