I just got my gp to send me the full dexa scan report. Can anyone advise how ' bad ' my bone situation is.
Ive recently been diagnosed with osteoarthritis in my left hand and forearm aswell.
my info -
age 53, post menopause ( had early menopause at 37-40 years old )
i have autoimmune thyroid disease and am on levothyroxine, and top up with self sourced t3 . My endo wont prescribe the T3 on the nhs because he says theres a risk with having surpressed tsh and oesteoperosis, or osteopenia , even tho he recognises it works and that im feeling better in regards to the thyroid condition by taking the T3,
I would appreciate advice on just how bad my bones are ?
I am taking calcium, vit d, vit k2 mk-7, aswell as zinc mangnesium, b vits and iron, ( all in easy to absorb formulas )
heres what the dexa says ( done 3 march 2020 )
T score total spine -1.4 Z score total spine -0.5
T score total hip -1.7 Z score total hip -1.2
T score NOF -1.8 Z score NOF -0.9
Comment - There is evidence of oesteopenia within the spine and also at the hip .
Protective bone management and ongoing follow up are indicated.
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MrsClanger
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I would read as much as you can about bone health start with the ROS website - they have lots of good leaflets but there are loads of good books about osteoporosis and osteopenia.Start eating the right sort of diet - look at the ROS bone friendly diet sheets - loads of dark green leafy veg etc, cut out rubbish / fast foods that don’t do your body any good, cut out fizzy drinks etc.
Make sure you get the vitamins and minerals you need for healthy bones and get good regular weight bearing exercise, I like the Margaret Martin book about Exercise for Better Bones book but again there is lots of information out there.
Like I’ve said somewhere else - I’d love to have your T scores.
Thank you, i eat tons of green stuff, as i only eat veg and nuts. I feel relieved as the endocrinologist said it was very bad and made it sound like my bones were disintegrating. I am going to register a formal complaint against him, as he clearly doesnt know how to interpret the tests.
Couple of things.....if your endo isn't working with you on T3 AND he's communicating that your DXA scores are "very bad", it might be time to search for a new doc. Yes, your scores are lower than women your own age & ethnicity (that's what the Z Score reflects), but "very bad" is high drama and inaccurate.
Also, if you're a vegetarian/vegan, your primary challenge will be getting sufficient protein to support/protect bone health. Insufficiency in this critical macronutrient is SO common. .545 grams of protein per lb of body weight is recommended. Protein/collagen is a fundamental building block of both bone & muscle. If you're lacking in this area, you will lose bone (and muscle) at a faster rate.
And....we lose bone rapidly in the 5 years that follow the onset of menopause. Are you doing HRT in any shape or form? Estrogen slows bone breakdown & helps mitigate loss during this challenging period.
Hi Deb, thank you for the stats, ive just added up all the protein in my diet.. and its looking ok.
i eat pretty much the same every day since april, Edited this as people probably dont need the full diet ( pure plant based no beans grains lectins or tofu )
Im eating 63.6g protein daily, I currently weigh 120 pounds so ( thanks for your info ) i need 65 g of protein daily. I am still reducing calories (1200 daily ) as im aiming for my goal weight around 112 pounds which will take my protein need down slightly, so it will be 61.4 g , so im pretty chuffed with my diet
I am post menopause, never done any hrt at all. Is it worth doing when so far gone past menopause ? im 53 now and started menopause age 37, been at last 12 years since i had any hot flushes , my last random period was about 9 years ago after 3 years of having none.
Even if you drop a few pounds, I'd recommend keeping protein where it is. That way, you've got a bit of leeway if some weeks are better than other.
Also, the bulk of research shows that proper nutrition & supplementation slow the rate of bone loss. That's great, but I wouldn't expect that alone to result in gains.
For gains, the body needs a stimulus to trigger osteogenisis/osteoblastic activity. Stress/compression on bone provides that stimulus, but it takes considerable levels of impact to affect bone materially. I'd recommend checking to see if you have an OsteoStrong center near you. Almost all locations give a complementary session so you can determine if it's a good fit for you.
Regarding HRT, it depends on what your osteoclasts are up to.....a CTX blood test will provide optics on that. If you're still losing rapidly, HRT slows that train. Phytoestrogens can also be utilized to the same end. Maryon Stewart wrote an outstanding book on the subject - "Manage Your Menopause Naturally."
Another alternative to HRT is Fosteum Plus, a medical grade food (fancy words for prescription-based supplement) that has been clinically shown to both slow osteoclasts and boost ostoblast formation. The "magic sauce" in Fosteum+ is genestein - a phytoestrogen.
I would be ecstatic with those results. Make sure you read as much as possible about looking after your bones and not just from ROS and also weight bearing exercise regimes walking ,yoga ,dancing , pirates etc. X
You are at the better end of osteopenia - great scores of which most others would be very envious! A T-score compares your bones to those of a healthy 30-something woman, the Z- score to those of someone your age.
Here is the range used by medical professionals to class your bones as osteopenic or osteoporotic:
T-score of -1.0 or above = normal bone density
T-score between -1.0 and -2.5 = low bone density, or osteopenia
T-score of -2.5 or lower = osteoporosis
You are taking all the right supplements and presumably have a good diet as well. Unless something changes dramatically, I would say you are a very long way off being prescribed any drugs. A diagnosis of osteoporosis with a fragility fracture is generally the trigger but some doctors jump the gun and prescribe drugs unnecessarily to their osteopenic patients. I'm not saying that yours will, but be on the lookout for this as it can be a slippery slope, depending on what you're prescribed. The side effects of a lot of these drugs can be quite horrible, so don't start taking anything unless absolutely necessary.
You might find this of interest hindawi.com/journals/jeph/2... a study of the combination of micronutrients for bone. You are taking most of these anyway, so are obviously well informed already.
It's on the good side of osteopenia. While it would be better to have normal bone density, you are in pretty good shape. Most of us, myself included, would love to have those numbers. The main thing to keep it from getting worse. If your CTX is high or a follow-up DXA showed a large decline, that would be a problem.
We have a great deal in common. I went through early menopause for unknown reasons, but much early that you did (mid-20s to early 30s). I have Hashimoto's hypothyriodism (was diagnosed in 2017) and have been taking 75 mcg of levothyroxine daily since then.
Unfortunately, the doctors I've seen over the last 20 yrs failed me by never mentioning that I should get a bone density scan. So, when I had a routine DEXA scan done for the first time in 2019, at age 50, my lumbar t-score was -3.9. Note, I haven't have any fractures and I am a very active person.
So, I hope my NOT good t-scores, make you feel better I would be thrilled if my numbers were as good as yours. You will definitely want to take action to prevent more bone loss and depending on what you are able to do mobility-wise, you might be able to reverse your osteopenia through natural means or at least prevent it from moving from osteopenia to osteoporosis.
My vitamin D levels were lowish and I have really brought them up. I used to wear sunscreen every day--never left the house without it--and I have stopped wearing it unless I got to the beach at noon, which I don't do. I'm slowing increasing the weights that I lift and I have added back extension exercises, and heel drops, and I stop each foot 4 times twice a day (as if I am crushing a can), etc. Additionally, I have added in vitamin K2, and I now eat 6+ prunes a day and handful of almonds.
Note, I am taking osteomeds for now but am hoping they are just a stop gap until I can get my numbers up a bit and then just work on keeping my bones healthy through natural methods. If my numbers were as good as yours, I would try natural remedies before taking drugs but that is just me, and I don't know your full medical history.
hi, thanks for the info, its so sad they didnt test you sooner, i was left for years till they tested me too, im glad my scores arnt as bad as i thought, and feel for you. I take k2 aswell, and think diet is so important and like you ive been trying to improve it, i posted what im eating to someone elses reply, albeit weird as i am trying to heal myself with a lectin free vegan diet.
Like felines, I consider myself to be an obligate carnivore Note, I don't overdue the red meat or any meat for that matter, meaning my portions are not huge.
There was a study done years ago regarding which "diet" group had the "best bones" and vegans came in last place. The omnivores had some of the least healthy habits. They were more likely to drink, smoke, eat fast food, etc. but overall, they surpassed the vegans, as did the pescatarians and vegetarians, when it came to bone density. My point, make sure you are getting all the vitamins, minerals, and protein you need in your diet. I personally find it impossible to get the recommended 1200 MG of daily calcium from my diet without dairy.
It took me a while to find out how I could squeeze 1300 mg calcium into my diet, but if you look at the nutrition panel on all the products in the dairy aisle, and try a few of them, you may be able to find some you like. I found ricotta cheese has 240 mg in a quarter cup, so two of those (a half cup) will give you 480 mg. One slice of no fat American cheese gives you 300 mg I don't particularly love these foods, but I'll do it for my bone health. Edit: just reread your post. I thought you said it was difficult to get 1200 mg calcium in your diet. I skipped over the 'without calcium' part. Maybe my post could help someone else trying to figure out how to get calcium in their diet.
Yes, dairy products are my main source of calcium. I recently read that if you remove dairy, the average person gets about 200 MG of calcium from other sources daily. I just can't eat enough greens to get the recommended 1200 MG
I've always had milk in my diet, but years ago I made the BIG mistake of switching to skim milk. About 10 years ago, I switched to 1% milk so now I get a little needed fat with my milk.
I've also always eaten cheese and yogurt--I even used to make my own yogurt and it was delicious. However, I still think I was probably coming in a little short of the 1200 MG recommendation. Mostly because I don't consume that much food in general.
All/Most of the nutrition labels on foods in the US are based on a 2000 calorie diet, which really makes no sense--the amount of protein you need has nothing to do with how many calories you consume, is has to do with your body weight and how active you are. I'm pretty sure that in general I don't consume 2000 calories per day.
Based on this calories needed calculator mayoclinic.org/healthy-life... I should try to get between 1650 and 1950 calories per day.
An example of how much I eat: I was eating 1/4 cup dried oats cooked with a little smart balance (a butter alternative with olive oil and omega 3s) and about a teaspoon of honey or maple syrup. I talked with a dietician who told me that I needed to be getting a little fat, carbs and protein, at every meal, so I changed my oatmeal breakfast to 1/8 cup dried oats cooked topped with a little smart balance, 3 cut up prunes and a few almonds or something like that. This morning for breakfast I had about 1/4 cup cooked grits with 1 ounce of cheddar cheese and 1 finely chopped garlic clove and 1/2 a pear on the side.
Additionally, because there are other dietary requirements--4-5 servings of fruits and veggies per day, and recommended protein intake calculator.net/protein-calc... that's what becomes tricky for me, when again, I don't eat tons of food. The good thing is dairy has protein and calcium so when I eat dairy, I get both.
Before going to bed last night, I wrote down everything I ate yesterday. I wasn't hungry meaning I was satisfied the entire day. Note, I have NCGS (non-celiac gluten sensitivity) and I avoid gluten. After writing it all down, I thought, I need to make sure I eat more tomorrow. LOL.
Why was it a big mistake to switch to skim milk? Due to no fat in it?
Good point you made about eating little. Many days, if I'm going to eat anything, it's going to be my three separate servings of calcium. Sometimes that's all I eat. I wonder if it's difficult for anyone watching calories to get all the calcium they need.
When I'm researching, some other subject gets illuminated, like hydration, and I think, oh no, am I dehydrated? That could cause problems! (What you said about eating more tomorrow made me think of that).
Yes, the issue with skim milk is no fat. We need fat. Avoiding fat is really bad for your body. Fat also helps us absorb fat soluble vitamins in our food. Vitamins A, D, E, and K are all fat soluble. They say it is best to get good fats, such as fat from olive oil and avocados, and to avoid meat fat, but I eat the fat on meat. Fat is where the flavor is and I don't buy the whole all "meat fat is bad for you" thing. When I buy ground beef, I buy lean ground beef. When I cook a steak, I eat the fat that is on the steak. I probably have steak once a month so I'm not over doing it. Additionally, when I buy chicken that still has the skin on it, I eat the skin. I also buy whole milk Greek yogurt and 4% milkfat cottage cheese.
Eating too little, meaning not enough food/calories, is really unhealthy. Bones are not just made up of calcium. Protein is really important for your bones. Use the protein calculator link I included above and see what it recommends for your age and activity level.
I generally exercise every day. I used to take one long walk every day but Margaret Martin (MelioGuide.com) suggests taking two 20-minute walks to make sure you keep your pace up, so now take two 20+ minutes walks every day. Additionally, after years of my doctors telling me that lifting light weights was enough to stave off osteoporosis, which obviously isn't the case, I did my own research and discovered that you really need to lift much heavier weights to build bone. Since I don't have a home gym, I joined a gym at the beginning of the year, and I go to the gym several times a week. Note, I am being very careful and going slow. On days that I go to the gym, in addition to weights/weighted equipment, I also use the treadmill and that counts as one of my walks. Today, I walked a 15 minute 8 second mile, which is excellent for me--I'm 4'11" and haven't lost any height so again a 15-minute mile is very good.
In terms of staying hydrated, I was drinking 1/2 caf coffee but I gave that up at the beginning of the year, so for the most part, I have little to no caffeine in my daily diet. I usually drink water. I have a 20 oz. water bottle that I carry around and refill through-out the day. If staying hydrated is an issue for you, I highly recommend getting a water bottle. The one I use an insulated Contigo water bottle gocontigo.com/explore-produ...
I live in the South and we have mild-ish winters and hot summers. When I put ice in my water bottle, it lasts.
Additionally, both water and fat, help keep your body regular. I have hypothyroidism and I think that as most ppl age, myself included, things just sort of slow down and as stated before I have NCGS so I can't eat a big bowl of bran cereal in the morning. Water is really important for your gut and your overall health.
I'm not trying to lose weight, well sort of. I weighed around 100 lbs before COVID started and I left a job that required a decent amount of moving around to work from home. My WFH job required that I sit in front of a computer screen for 8 to 10 hours a day, which meant very little moving. I also turned to more comfort foods and then, over this past summer, I had to do the GLUTEN CHALLENGE to get tested for Celiac. Yes, I bulked up. I think I got up to around 112 or a little higher.
Since joining the gym and breaking my walks into 2 shorter walks, I have lost a couple of pounds and am at 108. I would love to get back to my pre-COVID weight, but my primary care doctor won't like it. She said that the extra weight was good for my bones. Also losing weight, the process of it, is not good for the bones. The truth is I'm not really trying to lose weight, it's just happening because I'm not eating junk food and I'm exercising more. I've even added 8-9 prunes to my daily diet, and I now eat 1 full serving of almonds (28 almonds) at least 5 days a week. I added both the prunes and almonds due to studies showing that they help improve bones.
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I replied with everything above the line a little earlier today. Now it is 9:40 PM Eastern Time and I added up how much calcium and protein I've eaten today. My calcium intake via my diet (so not including supplements) is 82.5% of daily requirements and my protein intake from food is 52.4 grams. LOL. I think I'll pour another cup of milk and that should help me reach the goal.
Here is the list of things that I ate today just to show that I'm really not eating a bunch of junk that I could substitute health foods for.
1/4 cup grits with 1 oz cheddar cheese and 1 garlic clove
As others have said, your bones are relatively in great shape.
Although the DEXA scan is still the NHS standard, some have questioned their results from scan to scan as unreliable / inconsistent. You might want to look into a REMS scan: osteoscanuk.com
as an alternative to better track your bone health as you age.
Bone thinning is a normal part of aging and can be kept in check by exercise, especially weightbearing exercise (as simple as regular walking, walking with a weighted vest, walking with Nordic poles, and other exercise like Tai Chi, dancing, etc.). You also need a healthy, balanced diet, and a few judicious supplements, possibly Vitamin D3 and Vitamin K2 would be sufficient, but these two are very important. "Osteopenia" is not a disease. Medical establishment and big pharma make it so, but it is just the way it is as we get older. The secret is to prevent bone thinning from developing into a dangerous level of osteoporosis.
If you find your next DXA scan is worse, despite doing what you can to maintain good bone nutrition and exercise, insist on a full evaluation of "secondary causes of osteoporosis". No one should ever take an osteoporosis drug unless absolutely necessary, and certainly never without full investigation of what may be causing bones to lose density.
Could not agree with you more about making sure your doctor has ruled out other causes of bone loss before slapping you on osteo-meds with potentially dangerous side effects. My endocrinologist checked nothing and I trusted him because I was already seeing him for my hypothyroidism. When I asked him for natural treatments for osteoporosis he had no suggestions other than walking and light weights, which isn't enough, and he never mentioned anything about taking K2. Additionally, when I got my second DEXA scan and met with him, the scan is performed at another facility that he's not associated with, he was complaining about how the report was written. As I started doing more research, I discovered that he doesn't even have the full report. He looked at the summary and nothing else. Yes, I am very unhappy with him and am working to figure things out on my own.
The link you provided is awesome. Here is a great list that you can point ppl too. It's a super detailed lists of tests ppl should at the very least discuss with their doctors prior to opting to take medication.
Yes, that's a pretty good site. Go ahead and point people to it, we need all the help we can get as so many people are led to believe that osteoporosis or even osteopenia is incurable and you always have to take pharmaceuticals. They are not always necessary, and a little prevention can go a long way, and even reverse bone thinning.
I hope you feel reassured about your bone health, Mrs Clanger.
This article goes into the history of bone density measurement, diagnosis and treatment and how the diagnosis of osteopoenia came about. I don't want to discourage anyone from being aware of their bone health and being proactive. I'm also not trying to discourage anyone from treatment when they and their medical advisors believe it's appropriate. But it's an interesting perspective on how the diagnosis and treatment of osteopoenia evolved and whether there's some degree of 'medicalising' age-related bone thinning. That said, there's a lot we can do to look after our bone health, regardeless of a scan result. It can complicate thyroid treatment, especially getting T3 prescribed, and I hope that works out for you.
How a Bone Disease Grew to Fit the Prescription
"The question before the experts in Rome then was this: Since after the age of 30 all bones lose density, how much bone loss was normal? And, how much put women at risk and therefore should be considered a disease?"
Thank you, ill definitely find this interesting. i dio feel relieved and a bit daft for being scared by the silly endocrinologist. ill still argue to get T 3 prescribed as i feel better on it. My gp is now worried about a liver test being raised , alcaline phosphatase is always a bit high, so im looking into that now, but its probably nothing too !
I can put yours in to perspective when you see my dexa results. My spine was -5.5 and Is now - 4.3 with treatment. I think my hip score is - 3.4. I can’t remember what it was.
You have the beginnings of osteoporosis but I amagine with the right food and supplements you may be able to reverse it. I would get a professional opinion. Mine is really bad and I’ve had seven fractures in my back and one In both my foot and hand. They were all spontaneous apart from my hand which I fell on.
There are definitely times when drugs are necessary. What I find so tragic is the lack of information given to us, men as well as women actually, but mostly women, on how to prevent bone deterioration. There is so much we can do in earlier life right through middle age to slow down bone loss, if only we know what to eat and how to exercise, and to ask for the right tests when it looks like there's a problem.
Definitely! There needs to be more information right across the board for Osteoporosis and what foods women should eat and what excercises Children should start early to prevent bone loss when they are older. Then go right through to old age. Had we all have known what could happen would we all be like this now. I don’t know. I suppose we would think it’s not going to happen to me. I definitely wouldn’t have thought it would happen to me. I’m the youngest of three girls and none of my Sisters have problems like I’ve got.
I went through early menopause. All of my doctors knew/know this. Not one of them said to me, women lose a ton of bone density w/i 10 years of menopause. NONE OF THEM. I've had decades to be working on my bones but nothing beyond, walk, lift light weights, and take calcium, has ever been said to me.
Since turning 40, I've had mammogram after mammogram and 2 of those needlessly led to follow-up ultra-sounds because I have dense breasts. I never got worried about the follow-ups because honestly, I just somehow knew that nothing was wrong. Everything always came up negative.
When I was around 20, I did find a lump in my left breast when I was doing my self-breast exam. I was in college at the time and my father had just recently been diagnosed with lymphoma so I was really nervous about it. I called the university health center and they said they could schedule an appt for me in a few weeks and I told the person, "No, I have to come in immediately. I'm having major anxiety," which was true, so she got me in the next day. A physician's assistant felt the lump said it was nothing and that I should just watch it for changes. I watched it for over 10 years and then one day it was just gone.
I laugh now because I guarantee if today that same thing were to happen, that lump would have been cut out and biopsied LOL. Anyways my point is, if the world weren't hyper-focused on breast cancer, maybe one of those mammograms I've had could have been a DEXA scan and my bone loss could have been caught when it was still osteopenia and not osteoporosis.
There was every reason in the world for a doctor to schedule a DEXA scan for me when I was in my 30s (early menopause, petite, fair skinned) and they all failed me by not scheduling/recommending it. I've always been aware of the risk of osteoporosis because of my genetics but I didn't know that women lose so much bone during and immediately after menopause, and I don't have any fractures.
I told my niece that when she hits 30 to call me and if she can't afford to pay out of pocket for a bone density scan, I'll pay for it.
Well you were more aware of it than I was. Even when I had my first back fracture and it wasn’t diagmosed I had no thoughts of Osteoporosis. I think I would have been majorly worried if I found a lump in my breast too. Now I would think about that but broken bones. No! I was petite mousey hair and fairish skin I wasn’t sporty at all which I suppose didn’t help.
Oh yes! I had a hysterectomy at about 32. I was given HRT after six weeks which I took for twenty something years. I had to come off it because of terrible migraines.
Your numbers are really really good! I would say keep with what you are already doing and do everything you can to stay positive and not worry.
A year after I was prescribed meds (and decided to not take them due to side effects), I had my annual with my GYN Dr and asked her what she knew about OsteoStrong. She went to her cupboard, pulled out their brochure and told me going there would help me 10x more than what she had prescribed me. You may have one near you. I would recommend checking it out. osteostrong.com (if this doesn't bring it up, google it. I'm not able to look up the exact site without losing everything I've written)
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Is DEXA scan results reliable?
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Advice please?
