Worried and confused

[rnb054]

New dexa scan (10/10/23) reveals some "good" news and other not so good news.

Left femoral neck is -2.6, right femoral neck is -2.6, Lumbar spine from L2 thru L4 T score is -3.2.

Compared with 2021, there is a 4% decrease in density in lumbar spine, 5% INCREASE density in left hip, 3% INCREASE density in right hip.

Report says there is "severe osteoporosis at L1 and L2, moderate osteoporosis at L3 and severe osteopenia at L4, lower levels are felt to be falsely improved, findings suggest severe osteoporosis lumbar spine, mild osteoporosis both hips".

Both the PCP and rheumatologist have suggested that I go on Prolia. So far, I have passed on their suggestions.

I have always been active, walking, hiking and other types of cardio exercise. Over a year ago, I implemented a weight training regimen, go to the gym often, and also take the prescription vit D (50K units), K2/K7, calcium, magnesium, etc. I am a petite, slim female.

Physically, I feel quite good but the report also mentions that I am at "Level #3 high risk of atraumatic fracture lumbar spine and hips, FRAX score for 10 year major osteoporotic fracture 23.6% and for the hip 12.7%".

This last part has me quite frightened. I just turned 73 last month.

Any thoughts would be most welcome.

[Met00]

Did you have the two scans on the same machine? It seems unlikely that your hips improved so much in 2 years while your spine worsened by a similar amount! Also, how can you have "severe" osteopenia, that sounds like a contradiction in terms! Have you had any fractures? If not, what's their basis for saying you have severe osteoporosis, how do they know your bones are very weak? I thought Prolia was only recommended for people who've fractured?

[Grandk23sc in reply to Met00]

Prolia is not just for patients with fractures. My bone density was very low and this treatment was an option.

[Met00 in reply to Grandk23sc]

I wonder if it's more widely prescribed in the US compared to the UK. The UK osteoporosis charity, the ROS, provides the following information (denosumab is the generic name for prolia): "Denosumab isn’t usually given as a first treatment for osteoporosis. It’ll probably only be an option if you’ve already tried one of the more common drug treatments, or if other treatments aren’t suitable for you." The issue with other drug treatments not being suitable is that if you stop Prolia, you have to go straight onto another medication, so there has to be something else that's suitable!

[dcdream]

I have worse scores than yours and am 69. The scores take into consideration your age, which is why they increase in the probability of moderate to severe. I look more at my Z scores than T scores since I do not believe that my bones at 69 should be compared to a 30 year old. I do basically the same as you and eat very healthy. I have never fractured or broke a bone in my life. I also do not take meds. Try to give yourself time to think through your next move so you do not make a decision based on fear and emotions.

[rnb054 in reply to dcdream]

Many thanks for your replies, dcdream and met00.

I am reaching out to this forum because I have found it incredibly informative and helpful. More importantly, I have found encouragement and support from the members sharing their own OP journeys, so thank you again dcdream.

I have some questions for the PCP and rheumatologist regarding this latest report. I especially would like to know what the radiologist meant by "lower levels are felt to be falsely improved". What does that even mean? In my review of earlier reports, I have never seen an "increase" in bone density, so it is possible that the exercise regimen may have helped some (I'm hoping), but I will ask the doctors.

I am also going to ask your questions, met00.

I don't have the depth of knowledge on this subject to objectively question the report, so I take it at face value.

Would love to hear other comments/suggestions.

Thank you.