Thank you for accepting me in your forum. I have been reading everything for the last few days and I find everything so helpful. Two years ago, my bone density included both hips and this year it only included the left hip. How can that be an accurate comparison. According to my bone density this year, my left hip is -2.2. total and -2.2 neck. Two years ago it was -2.7, but that was because my right and left hip neck was -2.7 and my left total was - 1.6 and right total was -1.9. I am really mixed up. BTY, both were done at the same facility and when I asked about why they are only doing one hip, they said they changed their protocol. Anyway, my doctor told me that my hip got much worse, told me it went from -1.6 to -2.2, but according to the report, I got when comparing the old report to the new, it says My hip went from -2.7 to -2.2.
Should I go somewhere else and get it redone?? I have questions about my spine, but I thought I would start here. Thank you in advance.
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Hummingbirdlover12
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I would say this is a very good example of the unreliability of DEXA scanning. How can your left hip neck have improved and your left hip total have got worse? Osteoporosis is systemic, meaning that we lose bone density at a similar rate throughout our body, unless there's a specific reason why one area is worse (wheelchair users, for example, may have lower density in their spines). If you get another DEXA done on a different machine, you won't be able to compare the results (another weakness with DEXA, because if results from different machines aren't comparable, how can you possibly know which result, if any, is correct?!)
Can I ask why you've been having bone density scans? Have you had a fragility fracture? Your scores are osteopenia, so if you haven't fractured, you're in a good position to slow down or possibly even prevent further bone loss, depending on your age, fitness and whether you're post-menopause.
Finally, there is an alternative option, but it may not be available where you live. It's a relatively new bone scanning technique called REMS, which uses ultrasound instead of x-ray, is much more fully automated than DEXA, far less open to error, and comparable between different machines. REMS gives t-scores and z-scores like DEXA, and also provides a bone strength score, which is far more relevant than t-scores for assessing fracture risk. The company that manufactures the REMS machines is called Echolight, so they may be able to tell you whether they're operational in your locality.
Thanks for posting! I have had similar questions. I would question the positioning of your body and how they ensure that the results are accurate. I have read that if your positioning is slightly off (like they didn't make you elevate your knees, which would effect the curvature of your lumbar spine), that it could effect results. Maybe ask for the actual bone density results which are given in grams per square centimeter usually and compare those numbers. I would also ask for the images because the algorithm can make errors in where it draws the boundaries around your bone.
I agree with Met00 that you are only in the osteopenia category so lifestyle changes via diet and weight bearing exercise, if possible, may help maintain your bone density. Also agree about the REMS test instead of DEXA.. I am searching myself (I'm in the US) for a facility that offers this. Hope this helps, best wishes to you.
These are excellent points. There are a lot of opportunities for operator error, and not all DXA providers follow all best practices or are accredited by the international society of Clinical Densitometry (ISCD).
It is highly recommended to ask for a copy of the full DXA report, not just the T-score. This can help with tracking comparisons over the years.
Thank you everyone for your replies. To be honest, I am a real mess over all of this. I am 67, menopause started at age 50. My mom had osteoporosis and throughout the years was treated first with fosamax then Reclast. Her numbers seemed stable but really hard to measure due to severe kyphosis and two hip replacements due to degenerative reasons. The place where I have been getting my mammograms does bone densities too. They were always done in the same office. This year, they moved the same machine to the radiology dept, hence, a different protocol and different operator. Two years ago my doctor told me to start medication due to the 2.7 result which is now 2.2, if you go by the femoral neck.
Some history; 14 years ago I fell down 2 flights of stairs with my spine bouncing on each step. Heard noise in the basement and ran down wearing slippers. Went to the ER because of a knee injury and right before I left, asked to have a x-ray of my back due to pain. As it turned out, I had a non-displaced fracture of L2, minimal height loss, remains stable. Even though, my doctor has been suspicious for years, I certainly would not consider that a fragility fracture!! Eleven years ago, my mom was sick and I was taking care of her for 2 months. After she recovered, the night before, I was to fly back home, we planned on a dinner and I was running around her house. I ran in the garage which had 3 steps and forgot about the steps and ran off of the top step into air and went flying and smashing down on the cement. I broke a front tooth, needed a root canal and crown, had a non displaced fracture of my knee and a non displaced fracture of my fifth metacarpal. I landed on the top of my knee and face and tried to brace myself with my hand. Again, I do not attribute these to fragility fractures, but am I in a state of denial??? No fractures since, but often running to urgent care asking for x-rays, everytime I think I injured myself!!!
So over the years whenever, I was having a bone density, they always included L2 in the calculations, which skewed the results, because of the the loss of height, therefore L2 had a much better reading. This year, the doctor decided to take L2 out of the measurements which made it look like there was a huge decrease from 2 years ago. There was an decrease but not the kind of decreaase she told me. So with L2 included this year, I was at -2.2, but removing L2, I am at -2.7. Two years ago if she removed L2, I probably would have been at -2.4 or -2.5, but was read as -2.2.
My history, I used to be a professional ballet dancer, so I am shocked at my readings!! I was an exercise fanatic, besides ballet going to the gym using weights almost everyday, But I did not eat dairy products for many years and never checked my D2 levels and when I eventually did it was low. Currently, I take 500 mg of Calcium a day, rest I get from diet and 1,000 mcg of D2. MY D levels stay between 52 and 63. Once I was taking 2000 a day and I ended up with levels over 100, so I cut back.
Anyway, during this last visit I could tell my doctor was angry at me because I did not start on medication and I could tell by her note to my gyn, that she was angry. I am scared to death of the meds due to the side effects. I am especially worried because the root canal I had 11 years ago has been sensitive for the entire time. X-rays continue to not show any problems, but it is possible that in the future, I may need to get the tooth pulled.
I try to exercise as much as possible but due to pain from a bad bunion, I am unable to walk as far as I want to. This is something I will need to have surgery on, but I have to move this year and due to the pandemic lots of things have been put on hold. I have stairs in my house and I try to go up and down 5 times a day, being very careful, lift weights and use a bike which I know does not help. I really want to try to do this naturally, but I am scared to death and I am scared to death to take the meds. I feel paralyzed and very hopeless.
I believe my bone densities got worse during the pandemic, due to lack of activity and my mom passed away and all I wanted to do was watch netflix.
I checked into REMS and they only have 3 locations in the US. 2 in New Jersey and one in North Carolina. I am 5 hours from the one in NC, so it is doable, but not easy.
A fragility fracture is one that occurs with little or no impact, such as falling from standing height. You know how hard you fell, but from your description they sound like high impact fractures.
Hi, I was reading your history from 3 years ago. Did you ever get the Rems exam and did you ever have to start medication for osteoporosis or did you stay stable with your regimen.
Yes, I had a REMS scan nearly 2 years ago, gave t-scores -2.6 in both hip and spine. DEXA 16 months previously had given hip -2.5, spine -3.6. I took Risedronate for a year after diagnosis, but gave up due to side effects (now 5 1/2 years since taking anything). I rely on diet, exercise and supplements.
Thank you!! Can you please tell me what supplements you take, and how you take them?? Can you also share what type of exercises you do. I have a problem with my foot, so I cannot do as much walking as I want to do. Do you continue to get the REMS test every 2 years?? Sorry for all the questions!!
I take Vit D3 at breakfast, with 3mg boron, and 500mg Vitamin C, 200mcg K2-MK7 with another 3mg boron and very low dose magnesium after my evening meal, zinc at bedtime, strontium citrate when I get up in the night. I was taking 4000iu D3, but have reduced it to about 2500iu, as my blood level was higher than necessary in April, hoping to get it tested again in August. I've tried magnesium in various different forms, but it either upsets my stomach or makes my dry skin much worse, so I've just started ionic magnesium drops to see if I can tolerate that. I do make sure I get plenty of magnesium (plus calcium of course) in my diet. I've been taking strontium citrate for about 18 months, only take half dose (1 tablet instead of 2) and most, but not every night of the week, so it probably averages out about 250mg daily, full dose would be 680mg. Strontium isn't suitable for everyone as it can worsen existing heart problems and raise blood pressure.
Exercise, I'm not as committed as I should be, as I can be put off by the weather (!) but I try to walk 2-3 miles 4 or 5 times a week, plus exercise with weights and resistance bands (aim for 2-3 times a week, but often don't achieve that). I do 50-70 heel drops daily and when I remember do a bit of hopping and/or jumping. I did try skipping at one point, must get back to that. I also do a few balance exercises from time to time. I've just joined a facebook osteoporosis exercise group, The Strong Bones Challenge, which I hope will inspire me to do more, and as a result have just started doing planks.
I'm having a second REMS scan next week, so it will be interesting to see whether I've managed to stop any further deterioration! When I had my last REMS scan they didn't include a bone strength score, so it will be interesting to see what that is, and really much more relevant than bone density.
Unfortunately, many times there are errors made by the person who interprets the Bone Scan. I have read up on this issue and from what I have found out: Research shows 98% of clinicians said that poor quality DXA reports were harmful to patient care due to many factors many factors can alter the outcome of these scans. Not positioned correctly on the scanner, is a biggie. Also found that incorrect demographic information was entered in before the scan was completed and interpretation of measurements. Go to a different provider. Errors in real-time daily radiology is 30%.
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