dexa scan on one hip

[Pretsini]

Hi,

got thr exults on a Dexa scan for lumbar spine, femoral neck, and left hip. Is it standard practice to do one hip only? If a hip measurement is missing, should I contact the hospital for the missing info or ask for a redo?

[Met00]

Yes, they usually only scan one hip, because it's expected that both hips will have very similar bone density.

[Pretsini in reply to Met00]

interesting. Some of the comments from the online community indicated that both hips were done, and my doctor seemed to think the results were incomplete, so I was wondering.

[Met00 in reply to Pretsini]

I think it depends on the facility. I'm in the UK and normally they just scan one hip here, but some places do scan both. Maybe it's different in the US? If your doctor thinks there's a result missing, perhaps he should be chasing it?

[Pretsini in reply to Met00]

I am in the US, so evidently fairly common here, too. My results indicated an increase in osteopenia, and she prescribed alexandronate (generic Boniva). I am trying to get a second opinion before taking it and instead implementing lifestyle changes. She says calcium supplements do not work, though why are manufacturer fortified foods going to work if calcium citrate taken with food does not?

[Met00 in reply to Pretsini]

Osteopenia isn't osteoporosis, so unless you've had a fracture, wouldn't normally indicate a need for medication! It's recommended (in the UK at least) to get calcium from diet rather than supplements if possible, just supplementing to top up any shortfall. Calcium won't prevent you from getting osteoporosis, although insufficient calcium will cause it, as the body prioritises calcium in the blood over calcium in the bones! It's also important to have a good blood level of Vitamin D, as that plays an important role in calcium absorption. One of the best ways of improving bone health is to get plenty of high impact exercise plus progressive weight training, alongside a healthy diet and supplementing where necessary to avoid nutritional shortfalls.

[Mark_ABH in reply to Pretsini]

Re. calcium supplements, they are recommended only to bridge the gap between your diet and the daily recommended intake. If you can only get, say, 75% of daily calcium from diet, you can top off with a supplement. Don't try to get the entire daily amount from supplements. And taking excessive supplements might cause other health problems. Even fortified foods seem to be superior to supplements alone. (Just make sure you shake up your fortified juice or almond milk before pouring because the supplements could settle at the bottom of the bottle.

More about Ca supplements here: americanbonehealth.org/nutr...

[Pretsini in reply to Mark_ABH]

Thanks for the info.

[Pepper60 in reply to Met00]

I am in the US and my scan did both hips. There was a significant difference in the femur neck with the left being -1.6 and the right being -2.5. Is this that unusual? I am now diagnosed as having Osteoporosis. Going back to 2013 my femoral neck right hip was -2.6 ( left was -1.7). I was never diagnosed with Osteoporosis before this year because the radiologist who read the scans previously reported on Total Hip, which was and is now only at Osteopenia level. I have refused meds for the time being as my right femoral neck has been stable for over 10 years.

[Met00 in reply to Pepper60]

Do you spend a lot of time hopping on your right leg or doing other exercises that would improve the bone density of your left neck of femur but not your right? If not, I can't imagine why there would be such a difference between the two scores and would definitely question that! It's more difficult to scan the neck of femur accurately than it is total hip, so I'd personally be guided by that result, particularly if you only have the one t-score just into the osteoporosis range. Having said all that, bone density isn't an accurate predictor of fracture risk, as it doesn't necessarily equate to bone strength; it's possible to have good bone density but poor bone strength and vice versa. The only way to know bone strength is either suffering a fragility fracture, which would indicate poor strength, or to have a DEXA that includes a trabecular bone score, or a REMS scan, which routinely includes a bone fragility measure.

[Cam11]

I’m in the US and they only scanned my left hip

[Cam11]

I was just prescribed prolia for osteoporosis but I’m not ready to take it. I’m looking at the side effects versus the improvements and it’s such a hard decision. If I didn’t have a compression fracture it would make the decision much easier.

[yogalibrarian]

The standard in the US is one hip and the lumbar spine. Some facilities (some doctors) will do both hips and the wrist. But usually the 2nd hip and the wrist are most often done if there is some reason to believe that the hip will not give reliable information.

I watched a webinar a couple of weeks ago that explained why -- but, I can't find it in my notes. I did, however, note that the forearm scan tends to overestimate BMD.

[FearFracture]

I think it depends on the imaging facility and/or how your doctor writes the referral. My very first DEXA was done in 2019. They scanned both hips and my lumbar spine. The same was done on my second DEXA in 2021. My mother had a follow-up DEXA done at a different facility and they only did her left hip and her lumbar spine. I was irritated about this. Seems stupid to not look at both hips for a person who is being treated for osteoporosis.

I recommend talking to the imaging center you use and if need be asking our doctor to write the referral for your DEXA scan requesting that both hips be scanned.

If you are in the US and being treated for osteoporosis, your insurance will cover annual DEXA scans. If you don't have low BMD, I think insurance only covers DEXAs for women over 50 every other year.

My last DEXA was in July 2021. Since I had my 1st zoledronic acid infusion in November 2021, I decided to wait until November 2022 to have my next DEXA--this will let me see if the infusion, along with all the dietary changes, supplements and exercise I am doing, has had an effect or improved my bones--fingers crossed However, since I have learned that DEXAs are often wrong for smaller people (I'm 4'11" currently weigh 107 lbs but for most of my adult life I weighed between 92 - 101 lbs) I am trying to find an imaging facility that has the add-on software so they can do a TBS (trabecular bone scan/score) when my DEXA is done. My endocrinologist, of course, wants my scan done on the same piece of equipment my last 2 scans were done on. So I asked the facility that did my previous scans what the out-of-pocket cost would be for a DEXA if I just wanted to pay for it myself, in case I end up having two DEXAs done, meaning one at the facility that has done my previous scans and one at a facility that has TBS capabilities, and I was told that if I pay for the scan on the day of service that it would only cost $85. If you are really concerned about your other hip and can't wait until your next DEXA you should ask your imaging center what they would charge you to re-do your scan.