Big improvement in dexa - could they have missed a fracture?

[xA-A-Ax]

I'm 27 and just got the results from my 3rd dexa scan (I've had one every 2 years since I was diagnosed with osteoporosis in 2017). They've all been different machines unfortunately – we've moved house a couple of times and with the NHS, location is everything. I asked for the same machine this time as I'm still very close to the last hospital, but they insisted I'm now out of catchment so couldn't do that. So anyway, I know I can't really compare, but these figures are all I've got to go on.

When I was first diagnosed 4 years ago I was -3.7 in spine (0.654g/cm^2) and -2.1 in hip (0.686g/cm^2).

My scan in 2019 showed -3.2 in spine (0.694g/cm^2) and -1.9 in hip (0.712g/cm^2).

My latest scan shows -2.5 in spine (0.774g/cm^2) and -1.5 in hip (0.760g/cm^2).

Even allowing for the limitations of different machines, I was shocked (in a good way!) by the spine result in particular. I feel like I've been doing okay with nutrition, my hormones are much better than they were and I've been doing lots of weightlifting. But I'm now doubting myself. It seems like a huge change in just 2 years, especially given I'm nearly 30. I've also had periods where I've had aches/pains twinges in my back.

The report includes a few notes about recommendations. It doesn't mention anything about fractures, but it also doesn't show the images so I can't see the structures myself. Realistically, is it possible they've missed something? Is it more likely that this big increase is the result of a fracture they haven't noticed? I know no one on here will be able to tell me for sure what's going on, but any thoughts would be appreciated!

[Sunseaandsand]

Hi,You do not say why your bone density was so low to begin with.

Was it caused by some form of medication?

Perhaps you can arrange an appointment to see the person who's care you have been under as they will be the best to answer your questions.

With the information you have given I would say you seem to be doing extremely well.

You are very young and that goes in your favour for re buiding new bone.

Whilst it is recommended to have dexa scans on the same machine it is as you say not always possible.

Putting that aside, the scan you had before your most recent one shows an improvment, so it is not a sudden jump.

Given that you have addressed other areas such as nutrition ( which you say is okay but do not refer to it as good) perhaps that is an area that you can improve on.

You also say you are weightlifting which is excellent, personally I would say this is where your aches and pains are coming from.

Go carefully though because even the most fit can have injuries.

You have not said what the recommendations were that have been made to you, are they suggesting having treatment for your osteoporosis?

If there was a fracture present I believe it would have shown when you had your dexa.

Dexa scans in my own experience are excellent for showing if fractures are present.

Even small changes can be seen, I really do not think you have cause to worry that you have a fracture, but I do believe you really need reasuring by the consultant or doctor whose care you are under.

Take care and I hope you find the answers to your questions quickly, in the meantime I would try hard not to worry because from what you say I think you are doing really well.

[xA-A-Ax in reply to Sunseaandsand]

Thanks for your detailed reply!

My problems with bone density are almost certainly due to being underweight for a long time growing up (between about 15 and 23) with no periods for a lot of that time. I've had various blood tests done and they've generally been okay – or at least, shown nothing to suggest other conditions affecting my bones.

I'm now back at a healthy weight, getting regular periods etc, so yes, I was hoping to see some improvement – I just wasn't expecting such a jump. I have been trying to be careful with the weights/be mindful of my bones, but equally I know you have to push yourself to make progress! I'm now deadlifting over 70kg fairly easily up from about 40kg about a year ago, so I know I'm stronger in general, I'm just paranoid I've done damage somewhere along the way! I know you can fracture without any symptoms at all which makes me so nervous.

Thank you anyway! I know no one on here will be able to say definitively what's going on, I was just curious to see if anyone had any thoughts or experience with lumbar fractures either being identified or missed on DEXAs.

[Sunseaandsand in reply to xA-A-Ax]

Hi,It is good to hear that you doing are so well.

A healthy weight, good diet and excersise is so important for our health and it sounds like you have worked hard to get where you are.

Please try not to worry about the aches and pains, believe me if you had fractured you would know about it!!

There are so many changes that occur after

spinal fractures.

In my own case even after the first one my physical health was affected.

Enjoy life, have fun, life is too short not to.Xx

[jamr]

IMO your results are positive as you have improved significantly over each 2 year period. Even given the variation in machines, and even different scans on the same machines your results are all moving in the right direction. 30 is given as max bone density age but this is average. Without knowing what caused your osteo in the first place, difficult to judge how you are affected by the maximum age = 30. Improved nutrition is a big discussion from Calcium to Vit D to Vit K2 plus a bunch of others minerals and vits required. Same with exercise, weight bearing exercise is required. Usually they xray you following dexa results like yours so should have picked up any fractures. I would imagine if you have been pushing weights for 4 years you should expect some muscle soreness, just depends on how severe. If you had fractures you would likely have serious pain and mobility issues, however if in doubt get x rays done alongside the dexa. What were your wrist results?

[xA-A-Ax in reply to jamr]

Thanks for your reply! I've just given a bit more detail in response to another comment above –

My problems with bone density are almost certainly due to being underweight for a long time growing up (between about 15 and 23) with no periods for a lot of that time. I've had various blood tests done and they've generally been okay – or at least, shown nothing to suggest other conditions affecting my bones.

I'm now back at a healthy weight, getting regular periods etc, so I was hoping to see some improvement – I just wasn't expecting such a jump. I have been trying to be careful with the weights/be mindful of my bones, but equally I know you have to push yourself to make progress! I'm now deadlifting over 70kg fairly easily up from about 40kg about a year ago, so I know I'm stronger in general, I'm just paranoid I've done damage somewhere along the way! I know you can fracture without any symptoms at all which makes me really nervous when I have had various aches and pains.

I had a thoracic x-ray a couple of years ago which was fine, but I've never had a lumbar one and this dexa report doesn't suggest getting one, just possibly some more blood tests. In the UK the dexa doesn't include the wrist, just spine, femoral neck and total hip. Normally reports give individual scores for 4 lumbar vertebrae and show images too, but this one doesn't – it just gives a total score, so I can't see if there have been structural changes compared with my previous scans 😕 it was also insanely difficult to get this report from the hospital, so I don't think I'm going to be able to get anything else from them!

[jamr in reply to xA-A-Ax]

You are still able to recover bone density in a healthy way well past 30yrs old, even though I have read on various sites that you cannot gain BDM after 30. Weightlifing and isometric are both good to increase BMD as well as muscle. Just make sure you protect your back when dead lifting etc, using straight back and bend knees, no twisting, and while its good to push yourself, dont go too heavy or over fatigue. If you injure yourself while you recover you will lose muscle and bone while the injury heals. Better to slow down a little and avoid injury.

[Houseelf]

The aches and twinges you mention could be muscular. I get that too sometimes. They won't give a fracture risk report because of your age or have detected a fracture as they are looking at bone mass rather than for a fracture. I've osteoporosis for similar reasons to you and also saw a slight improvement between scans in my 20s as the body is still laying down new bone. This stops age 30 when the skeleton sets. So keep doing what you're doing as it sounds as though it is really helping your osteo!