Dexa scan results meaning

[MrsPractical]

Hi Everyone

I have finally managed to get a copy of the results of the above which I had done early March. I asked for the scan because I was automatically put on Alendronic acid at the same time as Pred although I had no likelyhood of osteoporosis. It wasn’t until I joined this site I realised the harm it can do when not really needed.

These are the results

Site Region BMD T sc Z sc Interpretation

AP Spine. L1-L4 0.958. -1.7. 0.0. Osteopenia

Left Femur. Neck. 0.923. -0.5. 1.2. Normal

Left Femur. Total. 0.821. - 1.5. 00. Osteopenia

These results are consistent with Osteopenia.

l3L4 have been excluded from BMD average due to degenerative changes.

The spine was imaged from approximately T 4 to S1 levels. Assessment of individual vertebra was adequate from T7 to L4. No significant fracture was identified.

I am 74 years of age and have been on Pred since Nov 2021. I stopped Alendronic acid myself in December 2022.

I’m sure one of the very knowledgeable people on this site will be able to interpret this report fully for me. Own doctor didn’t even let me know results were back!

I don’t understand why they only refer to left femur as though I only have one leg, is this normal or is it because nothing was found on right leg.

Also are the degenerative changes about normal for someone of my age.

I have continued to take Calcium and Vit D tablet. Do you think I need that based on these results.

Thank you very much.

[PMRpro Ambassador]

They only scan one side - saves time and they assume both sides will be similar.

If I have understood the numbers correctly I wouldn't be taking a bisphosphonate - they are similar to my last dexascan results after 11 or 12 years of pred and the local osteoporosis guru just told me to carry on as I was, she had never seen such good results in someone on long term pred and I have never taken a bisphosphonate (well, just 4 tablets 14 years ago).

Don't know if the degenerative changes are "normal for age" - they are rarely mentioned that I have seen but they affect the density reading and can give a false result,

A t-score of -1,0 or better would be normal. -2,5 would be osteoporosis so you are closer to normal than to osteoporosis.

A study some years ago found that calcium and vit D supplementation seemed to have a protective effect agains loss of bone density. I take vit D, 4000 IU daily, but not calcium - just eat more cheese, Supplements caused me bladder problems.

[MrsPractical in reply to PMRpro]

Thanks for your helpful reply.

[Predniso141 in reply to PMRpro]

I am 77 and was diagnosed with osteoporosis in my 50’s.. Decided against any of the “bone building” medicines, stayed with yoga three times a week and vitamin D3 and calcium. Drink milk and eat cheese. My last dexa scan was so bad i have decided i do not NEED anymore dexa scans! I guess i am too stubborn, but my Doc has now mentioned an infusion called PROLIA. Has anyone had any experience with side effects from Prolia . I dont want to have a PMR flair or any other side effects.

[PMRpro Ambassador in reply to Predniso141]

Not an infusion - not here anyway - it is a subcutaneous injection every 6 months. My husband was put on it after a spinal fracture and a dexa t-score of -3.7. The consultant was surprised but I don't know why - I expected it given his weight, diet and exercise, or rather lack ...

It didn't seem to bother him and like his mother if there was a side effect to something, he'd develop it!

[Janetknit in reply to Predniso141]

I was out on Tymlos, a nightly injection for the past two years… I had two fractures in my spine. I responded very well to these injections. They are bone building injections and I have had no further fractures. There was no complications with Prednisone and I am finishing my last month on this treatment and would say it was a successful experience. I am to have a new scan before November when I return to my endocrinologist for evaluation. The follow up drug will be Alendronate which I began last Wednesday.

[Predniso141 in reply to Janetknit]

Thank you

[DorsetLady PMRGCAuk volunteer]

As we have said many times your DEXA may show osteopenia but that doesn’t automatically mean it will become osteoporosis even when on Pred .

Did they scan both hips? Not mine, but the one had been replaced anyway.

Most people in their 70s probably do have osteopenia. T-score between -1.0 and -2.5 reflects osteopenia, so yours is okay. My last scan was about 3 years after coming off Pred, and slightly better that yours, but the report suggested I stay on Calcium/Vitamin D supplement so I have.

[MrsPractical in reply to DorsetLady]

Thank you for your reply. Happy to continue calcium and vitamin d even though I have a good amount of dairy products. Don’t think it does any harm but don’t worry if I forget to take it.

[DorsetLady PMRGCAuk volunteer]

I’ve been taking Adcal-D3 since April 2012… no issues.

[MrsPractical]

Thanks for reply

[Doraflora in reply to MrsPractical]

Hi there. Would you mind telling me why you decided to stop AA?

I was automatically put on it when first diagnosed with PMR in March 2020. I am awaiting my dexa scan results so it will be interesting to see what that shows.

I’m eager to stop any med if I don’t need it! I’m currently on 4mg of Pred and don’t have any pain.

[MrsPractical in reply to Doraflora]

Hi

Right from the start of Pred I was given Alendronic Acid because the doctor “said we might as well” Although it was only once a week I hated having to get up earlier and stay upright once I had taken it. I accepted that I needed it but at every opportunity questioned why. When I found this site and fully appreciated the harm it can do, it made me question even more. I had not been given a scan, I had a diet high in dairy products and always have since childhood. I hadn’t got a history of broken bones other than toes and once from a really bad fall. There was no family history either.

I was really fed up taking it and was considering stopping. I had a review of medications with the surgery pharmacist and much to my relief he agreed with my thoughts and said he could arrange a dexa scan and it would take about 2 months he asked me to continue until I had the scan, however after waiting to hear about a scan for two months I decided to stop. It turned out to be 5 ,months before I had the scan and a further 5 months before I had the results. Just shows my gut instinct was right. I just wonder what it cost the nhs for no good reason.

I have also managed to get off blood pressure tablets by changing habits gradual reduction of Pred and taking regular recordings of bp until gp eventually agreed I could stop.

Hope this helps you decide.

[PMRpro Ambassador in reply to MrsPractical]

The cost of AA is a lot cheaper than that of a broken hip which is probably how they justify it. The actual cost of a dexascan isn't massive but they are difficult to access - writing a script isn't.

[MrsPractical in reply to PMRpro]

That explains it then.

[Doraflora in reply to MrsPractical]

Thanks Mrs Practical. I’ll definitely review the AA after I get the results of the Dexa scan.

I’ve been on BP meds for the last few months. They have reduced my BP quite a bit, but once I reduce my Pred even further, I really hope my BP Will reduce. (It was always low pre PMR, but then I was nearly 4 years younger).

It seems when you hit that number of 70 years they always seem to say “as we get older “. They never said that pre70🙄

[PMRpro Ambassador in reply to Doraflora]

Actually, the ED starts saying it after 55!!!

[piglette]

I take vitamin D with calcium and my results are all positive. In fact stainless steel bones level!!

[christi48 in reply to piglette]

Lucky you!

[piglette in reply to christi48]

The rest of me is falling to bits though!

[MrsPractical]

Well done!

[HeronNS]

"Degenerative changes" are likely some osteoarthritis, and those areas excluded because it does make DXA scan inaccurate. Agree with PMRpro that your results show you do not need bisphosphonates. If you would like to help keep your bones that way you might like to read my story for some ideas about how to maintain (and even improve) bone density without drugs.

healthunlocked.com/pmrgcauk...

[MrsPractical in reply to HeronNS]

Thank you. Yes I have read your interesting post previously. Well done.

[TheMoaningViolet]

Hi, I took AA for 8 months until I reduced my steroids to 5.5 mg and then I stopped. The rheumatologist showed me the study that suggested most potential damage occurs in the first six months of steroid treatment and that persuaded me to take it. You can't be sure how your body will respond and everyone needs to decide for themselves. My last DEXA was absolutely fine, but than I am 20 years your junior. The doctor when looking at my good results remarked that of course AA would have helped with maintaining my bone health. Who knows?

I take Calcium Citrate (only once per day), K2, D3, Magnesium and have plenty of green vegetables, cheese and yoghurt, and a bit of double cream in my coffee. It occurred to me today (as I carried my laptop on my back, walking briskly to work), that going into my office twice per week, loaded as I am, is quite a good exercise for my bones.

[darkred in reply to TheMoaningViolet]

Seems your supplement intake is excellent. Good that you take K2 also to send calcium to your bones instead of your blood vessels. (I learned this only about a decade ago.) On this forum, I learned that calcium should not be taken close to prednisone, as calcium may hinder absorption of prednisone. I've also read (not here) about some other "rules" when taking these supplements. I may have to disregard these other rules as the complicated rules result in my missing my daily dose of bone-sparing supplements. I do wonder if acid-inhibiting drugs such as cimetidine or PPIs may inhibit absorption of calcium! Consensus is that calcium is best absorbed in an acid environment.

Another "rule" is that fat-soluble vitamins such as D and K require an intake of some fat to facilitate absorption. Those who drink milk, eat cheese or Greek yogurt containing fat don't have to worry, if taken with D and K.

I always buy a calcium/magnesium combination. Yet, one will read that these minerals absorb better if taken at different times. Still, when taking a multivitamin/mineral tablet, all minerals are thrown in together: calcium, magnesium, zinc. It's a good thing that iron is not included in multivitamins for seniors, as that would be an inhibitor for the absorption of other minerals.

[TheMoaningViolet in reply to darkred]

I think the issue is that Prednisolone may reduce calcium absorption, but I may have misremembered it. I take a few vitamins I take separately, but I have no idea how much they help. PPIs definitely inhibit calcium absorption which is why osteoporosis is one of the side effects of the long-term use. Eating well is probably all we need. I read a lot about osteoporosis after my father died (he had back surgery because of a bone fracture) some eight years ago; this is when I learned about K2, but the regulars on this site knew all about it.

[PMRpro Ambassador in reply to TheMoaningViolet]

Works both ways - calcium taken at the same time as pred tablets is found to coat the outside of the pred tablet, hinders the breakdown of the tablet and reduces the absorption. Pred taken at the same time as calcium reduces the absorption of calcium in the lower GI tract.

[DorsetLady PMRGCAuk volunteer in reply to TheMoaningViolet]

You’re correct on the Pred/calcium issue.

[MrsPractical]

That sounds good. I’m afraid my walking has been very limited since PMR.

[Sweetpeasoprano]

My husband was diagnosed with osteopenia several years ago (after near fatal cardiac arrest - long story) and takes calcium and vidD supplements. Alendronic acid was never suggested but of course he was on all sorts of other meds after the heart stuff.

My own DXA scan showed no sign of any probs but I was advised to take Calcium and vit. D supplements until I was off pred. I am down to 1mg after starting on 15 two years ago. 🎉

[TheMoaningViolet in reply to Sweetpeasoprano]

That's a great progress! It took me almost 3 years to get down to 1 mg. This was in September last year. I've been reducing to 0 ever since. I do feel different every time I extend my taper.

[Sweetpeasoprano in reply to TheMoaningViolet]

After the initial 15mg for very classic PMR symptoms where I was totally incapacitated in the mornings though I still carried on as much as I could, I have reduced very very slowly over the 2 years. I’m lucky that there have been no flares and I resumed my usual active lifestyle of 4-5km walks a couple of times a week, Pilates on line most mornings and Granny duty quite quickly. We’ve just had a very busy couple of months looking after various combinations of a 12 yr old, two 10 yr olds, a 27 month old and a 21 month old! Fortunately Grandad is very hands on and will even do pooey nappies. I have said on other posts that I am one of the lucky PMR victims as far as recovery goes (so far🤞).

[TheMoaningViolet in reply to Sweetpeasoprano]

Indeed, just keep on doing what you do. ❤