Dxa results puzzle me

[Graceissufficient]

Question 1

There seem to be two kinds of T score - one plain T score, one "adjusted for TBS" which is much lower.

When people talk here and articles discuss T scores which do they usually mean?

Question 2

I have a clear OP diagnosis from the scores, let alone the existing L1 moderate compression fracture. My fracture risk is 16 per cent in next 10 years, which is relatively high for age but below the line for giving drugs.

I'm happy with that, prefer to try everything else first and also try to exclude causes.

But no blood tests offered. I asked if I could be referred to a Fracture Liaison Service and he said "What's that?"

I need expert physio advice at least to know how to reduce on going damage (I know there is some on line, but it's hard to personalise it to your injuries and conditions.)

He was happy to refer but didn't know where short of rheumatologist.

There must be a FLS in London. Do FLSs offer expert OP physio? Would they accept a reference?

Thank you all for your patience. There's a half hour wait on the OP helpline which I can't do, and anyway I think you as a community know as much if not more as anyone.

[Cilla65]

Hi,

I cannot help for all your questions as I live abroad, but to my knowledge the TBS score is derived from an algorithm that uses the dexa scan results focusing in establishing how is the quality of the internal micro architecture of the bone in particular the trabecular components, let’s say that it is a more accurate assessment of the bones. Absolutely ask for blood tests, including the bone turn over markers, for primary conditions which induce OP as no medications are the same and right for everyone, to the point to be counterproductive, depending on the root causes of your low bone density. Keeping in mind d that low bone density is a possible factor for a fracture and not a sure thing. I was advised to eat more protein, add some integration (I had low vitamin D) so vit D and K2 plus collagen, Vit C (from fruit and veggies) plus a couple specific for me and prescribed by my specialist. I was also suggested to start brisk walking at least 5km for 5 days (and you can grow on this) walking straight snd including stairs so that your head (it weights around 4/5kg) helps to build muscle and that help the bone formation. Having, if you can, a little jog downhill also is a good addition as compared to uphill and this is due to posture. Plus I exercise for 20/30 min 2-3 times a week with light weights ( I can’t use heavy weights for my retinas) so I do repetition, lounges, sit ups not on the floor but on the back of my sofa, balance exercises. I was instructed by the specialist who works with physiotherapists. Another thing I do often when I stand for instance washing the dishes I drop on my back foot or stand on a leg. I was told not to turn on my waist while carrying weight (for example putting the grocery from the trolley into the car), that kind of torsion with a weight is potentially harmful, more in general use your legs instead of your back to pick up things. I hope this helps a bit. Good luck!

[Verauk]

Dear Graceissufficient I'm not sure if a can answer correctly.

Regarding question 1: At the country where I live, at the result of my DEXA, it is shown only one value . I will attach here my last result.

Question 2: I ask here, about vlood tests ( PN1P and CTX) but any doctor as asked me those. In my next return( June) I will aks for it. i have contacted a lab and I can do without a doctor request, and by the way these two are expensive 100 USD. But I should have done it before start the medication, and unfortunately it is not what occured.

[Posy-White]

Hello Graceisufficent,

Do you mean you had 3 sets of scores from the Dexa scan?

I had thought the TBS -trabecular bone score, was the baseline showing how well or poor the individual bone is doing and when adjusted for age with the T score things for anyone over 30 tended to look better as we all loose bone density as we age. However I'm begining to think 'what do I know' and I'm very interested to hear others views.

I'd think it worth going on the waiting list to see a rheumatologist. Perhaps in the meantime you could ask your GP for Vit D blood test checks, to make sure you have enough especially in the winter months and have a blood test to check for bone turn over to give a further picture of what's going on.

I tried various private Physios before finding the right person to help me (I'm not in London). I wonder as you are in the London area if an other Member of the local OS group could help with suggestions - sometime word of mouth gives the best results. Or you might find a local Hydo / Palates group with a therapist who understands the needs of people with OS. I understand what you mean about the online videos, is it worth trying the easiest ones from the ROS website first and working your way up to a level that feels oay for you? (That's what I did before I found the right help).

God Luck

Posy White

[Graceissufficient in reply to Posy-White]

Thanks Posy. No, just two T score sets - the basic T scores, which seemed not too awful, -1.9 and -1.8 along with the Bone Mineral Densities for lumbar vertebrae and the hip.

Then the computer adjusted those scores for TBS, trabecular bone, and came up with a new "BMd T score adjusted for TBS" which was much more depressing, -3.5 and -2.6.

Thanks for your advice - I might just dig into savings and have private blood tests to avoid the stress of more GP interaction.

[Cilla65 in reply to Graceissufficient]

Hi, for what I know the trabecular bone (internal component of the bone especially in the vertebra) is the component most affected in the post menopausal OP. I watched a video from a US expert (interviewed by Margaret Martin a very famous OP physiotherapist) and he suggested that scans are like a photo of what happened to your bones so far (including TBS) and bone turn over markers blood tests are the photo of what is happening right now. It made clearer to me the importance of both as the bone is continually changing even though slowly and support the idea that bone turn over markers are the main indication of the efficacy and patient’s adherence to treatments especially with drugs and in general in which direction your bone health is heading.

Have a great day

[Graceissufficient in reply to Cilla65]

That's very clear and helpful. Makes sense. So I should have my bone turnover measured when I get the energy - thank you.

[Armagnac]

Firstly I imagine most people are talking about basic T score. The other is about calculating the fracture risk. BUT I fractured three vertebrae as shown on an MRI scan. My DEXA scan showed 9.8% fracture risk. However two rheumatologists both said (at that time) you need teriparatide. There are other drugs now but clearly they didn’t think much of the NICE guidelines on this point.

[Graceissufficient in reply to Armagnac]

Yes Armagnac. A very useful point. Actual existing fractures, height loss and visible bone damage clearly not given enough weight in the calculation. It is obviously v rough. My GP would have referred me to a rheum if I had wanted, to be fair, because I was "on the border".

[questionably]

This is a frax risk calculator frax.shef.ac.uk/FRAX/tool.a...

Trabecular bone score compares your bones to a standard derived from a set of thirty year old women. The number is the deviation.

TBS is a newer calculation of the quality of the internal bone structure derived from the same dxa images by software added to the dxa machine. intended to measure the strength of the bone, as the T score only measures mineral density.

[Graceissufficient in reply to questionably]

Thanks questionably.

I'm going to take more supplements, up the green veg, try to remember my back and neck in all movements, reduce the red wine😩to a mingy level and take it easy till my concussion resolves. After that I expect I'll find some further strategies, but since currently I find myself losing the ice cream because I've put it in the microwave, that stage had better wait.

[DemBones2024]

The bit I don’t understand is how you are expected to have the bone density of a healthy 30 year old when in your fifties or older!?

[HeronNS in reply to DemBones2024]

Some years ago there was a little gizmo being used to measurrre bone density of the heel. Apparently it wss completely useless for determining one's actual risks and, yes, it was being distributed to pharmacies, etc., to encourage the prescribing of bone medication. I guess the DXA scan is better than that, but it doesn't give the whole picture by any means.

[Graceissufficient in reply to HeronNS]

Quite.

[questionably in reply to DemBones2024]

DemBones22024, how many of us had that bone density when we were 30. We aren't actually expected to maintain density after the loss of estrogen. We are expected to lose density at accerlerated rates in the first five years after menopause--no matter how perfect our exercise routine and diet.

[ROSModerator Partner]

Hi all,

Just dropping by in case anyone comes across this thread and would like more information about understanding scans and tests: theros.org.uk/information-a...

Wishing you all the best,

Lulu

ROS Moderator

[Graceissufficient in reply to ROSModerator]

Thanks Lulu. I did look at that before posting, but it didn't answer my question that I could see.

[TandemTime]

I would definitatey get referred to the Rhemy since it was offered. The appointment will take a few months to come anyway. They will guide your GP about the blood tests and will be really helpful. Less stones left unturned.I have a good physio who suggested many of the same things as Cilla65. 😀 However I was told not to do sit ups at all, but told to do press ups against a wall making a triangle of pizza with my arms. I like that as can do it in the kitchen whilst waiting for the kettle.

The physio also suggested 2 x1Kg weights which I also keep handy in the kitchen and spend 2 or 3 minutes a few times a day lifting . I was told not to put them to wide they must stay in sight, except above your head where you will obviously not see them. Little and often was suggested and they are cheap to buy.

I am having Kefir every morning as it seems an easy way to get calcium using the calculator from the OPS as I am worried about taking it as a supplement so only taking low dose with vitamin K etc at the same time. Worried about calcium supplements jamming up my pipework so trying to do it with food instead where I can. ...

I managed to cut my alcohol intake yesterday with a 'look a like gin and tonic' which meant I had less wine when we ate out Sat night. I hate coke etc so looking around for what else I can drink!

Good luck...

[Graceissufficient in reply to TandemTime]

V helpful, thanks Tandem.