DXA: "Those with small bones may be o... - Osteoporosis Support
DXA: "Those with small bones may be over-diagnosed; those with large bones under-diagnosed."
Thank you! As a person with smaller bones, data like this helps me explain to my doctor why I have more confidence in my REMS scores than my DEXA scores—and am reluctant to take strong medications.
Dr. Aliya Khan provided some insights into the soon to be released osteoporosis guidelines to Canadian physicians. "Remember to always treat based on fracture risk. It doesn't matter what the bone density is. We need to know about their fracture risk."
Please continue to share any updated information/research from Canada. Much appreciated.
I post primarily on the Facebook group "Osteoporosis Education and Support Group." My interests have been the complexity of bone strength, DXA errors and exercise. I have 'saved posts' on these topics with various articles/presentations. I will post the new Canadian guidelines here.
Dr Aliya Khan is my doctor. I have low fracture risk and she has me on alendronate, so not sure what that means. I too am wonder about the small bone research, as I am a small person.
I am surprised Dr. Khan would suggest medication for someone at a low fracture risk.
Good to have a recent study that demonstrates what a difference bone size can make. I learnt recently that there's a formula that allows you to tell whether your own bone size is small, medium or large, depending on your wrist size, with basically a small wrist being evidence of a small skeleton. Perhaps they should measure our wrists and adjust DEXA results accordingly.
Thank you for sharing this new research which helps me understand why us folks with smaller bones are told due to our weight, are high risk for this disease. This is very interesting research.
My post this morning on a FB group:
A member posted yesterday that she had a DXA in her 30s and was prescribed an anti-remodeling medication.
This 2020 review by the IOF and the ECTS states:
"..... a low areal bone mineral density (aBMD) alone at a young age may reflect a relatively thinner skeleton, for instance in a constitutionally lean person, but with normal volumetric bone material density (BMD) and no alterations of microstructure (ie, not necessarily more fragile bones)."
Yes, there is research that shows that is true. The basic problem is that you are creating a 2-dimensional representation of a 3-dimensional object (the spine). So if you have a small (or very large) stature, the interpretation can be skewed a bit.
That is one reason to have your DXA done and interpreted by someone who is a specialist (an ISCD-certified Clinical Densitometrist). If your DXA center does not have a CCD at least have the treatment discussion with a specialist.
Self-interpreting your bone size may not be helpful in a treatment decision. Do you remember the era when the height/weight charts used to include bone size? I remember a lot of women (about my mother's age) saying "I'm not fat, I'm just big-boned," when in truth they were overweight.
So take bone size as a clue to be explored further, not as an answer in itself.
I could not possibly agree more. Bone strength is complex. As the newly elected president of the ASBMR, Dr. Mary Bouxsein has noted: "For any given BMD there is over a two fold variation in strength suggesting that BMD alone does not capture all the characteristics that we are interested in to be able to predict strength, estimate skeletal fragility and fracture risk." 8.36 mark vimeo.com/605067786?fbclid=...
Did you see this in Healio yesterday, yogalibrarian?
Tool for measuring bone fragility in older women receives breakthrough device designation
"Even modest bone loss producing osteopenia concurrently destroys the architecture of bone, which weakens the bone greatly," Ego Seeman, MD, medical director of endocrinology for CurveBeam AI and professor of medicine and endocrinologist in the departments of medicine and endocrinology at Austin Health and the University of Melbourne in Australia, said in a press release. "An increase in holes in the outer shell of the bone reduces bone strength to the seventh power, loss of the inner honey-comb spongy bone reduce strength to the third power; disproportionate to the bone loss producing this destruction and disproportionate to the modest reduction in BMD found in osteopenia.” healio.com/news/endocrinolo...
Thanks. I've been away and I'm a bit behind on my reading.... I attended a webinar a couple of weeks ago where the presenter had some slides that made that graphically clear. "Only osteeopenia" or "only lost a little a little bit of BMD" looks really different if you look at that support structure.
