DEXA with missing Ls as fractures

[cmoc]

My DEXA Scan in 2017 was AP spine L1, L2 and L4 was

0.640, - 3.6 - 1.9 osteoporosis

Femoral neck (left) 0.624 -2.0 -0.6 osteopenia

Total hip (left) 0.726 - 1.4 - 0.2 osteopenia it says L3 was excluded due to presence of degenerative changes

My DEXA in 2019 was AP spine L1, L2 and L4 was 0.647, -3.5 -1.7 osteoporosis

Femoral neck (left) 0.607 -2.2 -0.6 osteopenia

Total hip (left) 0.780, -1.3 -0.1 osteopenia

LAST DEXA 2022 is AP spine L2 and L4 (L1 missed as fracture) 0.581, -4.5 -2.4

Femoral neck (left) 0.520, -3 -1.2

Total hip (left) 0.724, -1.8 -0.3

Then it says L1 has been excluded because of a fracture and L4 has been excluded from the spine report in order to accurately compare the previous

scan.

Then the following page (I didnt have this on the other DEXA scans) says ....

AP Spine L2 and L4 -4.5

In 2019 -4.0

in 2017 -4.2

Then theres lots of - percentages figures

Because the typist didnt have the figures in tabs its difficult to read, but I was wondering how much I have gone down over the last 3 years, as the main score I had for 2017 and 2019 was -3.6 and -3.5 and this last one was -4.5 Yet the figures on the next page showed -4.2 and -4.0 so does that mean I have gone down

from -4.0 to -4.5 (which isnt quite as bad as me going down from -3.6 to -4.5, (although still not good).

Can they accurately tell, if using only two vertebrae for the spine as others are excluded?

Would be grateful if someone could explain these figures to me as I dont understand.

Thanks for any help.

[Met00]

The updated figures for your spine allow a comparison to be made with the same vertebrae in each scan, which is why your previous scan t-scores suddenly seem much worse. I'm not sure which vertebra(e) they've included though, as you say they've excluded L4, but then the result says L2 + L4. There's little point in giving a spine score with just one vertebral measurement, because it's important to have an average. Ideally all 4 vertebrae should be included for the best chance of an accurate assessment, 3 vertebrae should be reasonable, 2 vertebrae would be highly questionable! So basically I would ignore the spine score!

Having said that, you've had a spinal fracture, which is a much better indicator of poor bone health than measuring bone density. Your hip score has changed from -1.4 in 2017 to - 1.8 in 2022, which is about average bone loss. Normally you would expect all bones to lose density at about the same rate. Have they done any investigations into the cause of your fracture and apparent poor spinal bone density?

[cmoc in reply to Met00]

Thanks Met00 for the reply. I dont think investigations, not much anyway. I do know that in 2016 when I first had two fractures, my vitamin D level was below the reference range and I have since got that up to 90. Also, I had a bowel resection in 2014 (piece of intestine taken away) and I doubt I have been absorbing as well as I should. I had to have B12 injections after a burst appendix in 1986 as well. Also, never ate much dairy because of migraines, although I always ate loads of veg.

I have had 5 or 6 fractures now. Three lumbar and three higher up.

I was on Forteo for 6 months every second day, but have been trying to get another bone drug for ages, so the last 3 years, apart from the Forteo, havent been on anything, although supplemented with calcium Vitamin D, and eating all Boron foods loads of veg etc.

Extremely med sensitive (with M.E and vestibular migraines) which makes it difficult.

Hoping to get Evenity before Christmas.