DXA Scan

[Pusph]

Hi All. I'm looking for a bit of advice. I've eventually got the results of the DXA Scan I had done in November 2023! They are:Lumbar Spine T score -2.3

Total Hip -2.4

Left neck of femur -2.8

I've been told by my GP that I should be taking bone medication and been prescribed Risedrobate Sodium with I believe is Alendronic Acid. From what I can gather on here no one wants to take AA and many resist doing so and after reading the list of side effects I can understand why.

I thought I was going to see my GP about something completely different and when she sprung this on me I was totally unprepared and so didn't ask the right questions (or any really!) just mumbled that I really didn't want to be taking anything else!

My question is can anyone tell me if those scores are very bad, or slightly bad or really to be expected for someone my age (70).

I'm pescatarian, eat a reasonable diet I think, a lot of cheese. I already take Adcal Dissolve x 2 & Vit D & intend starting Vit K2 if I can get the go ahead from my doctor to be OK with my heart meds. I also walk quite a bit for exercise - between 6500 to 10000 steps a day. I really don't want to take this if I don't absolutely need to and I did get an impression that my GP was possibly just covering herself. I believe that PMRPro mentioned on a post recently that starting it is not a decision to be taken in haste? (But I may be wrong)!

I'd appreciate any opinions. Thanks.

[piglette]

You are getting to the osteopenia/osteoporosis threshold. I am amazed that your doctor has waited knocking on a year to give you the results. Personally I would not start on Alendronic Acid or equivalent until my T score was less than -2.5 but I am not a good person to listen to! You could try wearing a weighted jacket, also there is a lot of information on the Osteoporosis society website.

[DorsetLady PMRGCAuk volunteer]

WHO scores -

The World Health Organization classifies T scores as follows:

above -1 SD is normal

between -1 and -2.5 SD is defined as mildly reduced bone mineral density (BMD) compared with peak bone mass (PBM)

at or below -2.5 SD is defined as osteoporosis

So you are borderline - decision is yours of course and suggest you look at this and also contact ROS for further advice

healthunlocked.com/pmrgcauk...

theros.org.uk

Wouldn’t go so far as to say no one wants to take AA -I took it for 4years because I needed to with no problems whatsoever. Been off it for 8 years and still with no problems.

My advice to anyone is, and always has been, check if you really need it, if you do then take.. but if isn’t required, then don’t.

No one wants to take Pred either -but then no one wants to go blind with GCA -nor end up in a wheelchair and in pain with osteoporosis.

Seek more advice from the experts (ROS) and then make your decision.

[PMRpro Ambassador]

"prescribed Risedrobate Sodium with I believe is Alendronic Acid"

No, it is NOT alendronic acid - it is a different bisphosphonate with a much improved side effect profile.

Those t-scores put you at the borderline of osteopenia/osteoporosis and the worst score is in the osteoporosis range - and since that is your hip, you need to take it seriously. It is in an attempt to protect you from a fracture of that particular bone that you are being offered a bisphosphonate. A fractured neck of femur in an older person can be a life-changing event - sometimes resulting in considerable ongoing disability and occasionally may even be life-threatening in the longer term.

If your t-scores are in the middle of the osteopenia range then there may be no need to take the tablets - that is figures about -1.6 or so, Yours are far worse than that and at a level that a couple of years on pred while not taking them might result in much worse results. You are already doing your best with diet and exercise and your bone density is lower than is advisable.

It isn't only the density - even if the dexascan results are apparently good, it may not be enough to prevent fractures. The quality of the bone is also key. I suggest you read this post by tangocharlie - whose dexascan results were apparently good but who has had several spinal fractures:

healthunlocked.com/pmrgcauk...

Hers were particularly disabling and painful. I recently started a course of zolendronic acid infusions, 3 at yearly intervals, as a spinal x-ray detected a possible compression fracture. I had had severe back spasm pain for a couple of years but nothing had been seen on the x-rays my rheumy had ordered previously so it is impossible to say if the muscle problems were due to the fracture or not but while I didn't take AA when it was first offered with pred 15 years ago, I did say if it was needed, I would take it. And I have.

DorsetLady has given you the link for the ROS website and helpline. Speak to their expert nurses. If I said it wasn't a decision to be taken in haste, and I may have, it was because you need some evidence first. You have yours - your bone density is low despite good diet and activity levels.

[ChrisBeeLoop]

Our resident experts have given you excellent advice. I am a complete novice who was prescribed to take alendronic acid in my second month of Prednisolone. I was so shocked by the potential side effects that I didn’t want to take it. I talked to my dentist about the dangers of deteriorating jaw bones and he advised that was really in the case of high dosages such as are given to cancer patients. I argued with my GP that I thought my diet was high in calcium and eventually, reluctantly she referred me for a DEXA scan. Her argument was that you normally have the scan after 2 years or so of Pred, to see if any damage has been done. Personally, I wanted a baseline measurement.

My DEXA scores turned out to be spot on average, normal, for a 30 year old. I'm 75. So, personally, I feel safe not taking AA, but if my scores were on a par with yours I would most certainly be looking at something to beef up my bones.

There is another important measure which may or may not be included in your DEXA scan. It's called Trabecular scan and gives a measurement of the sponginess inside your bones. It might be worth checking with your doctor if that was included in your scan. It wasn’t in mine and I have just enquired and the cost of a private scan is around £295.

Good luck with everything but please think carefully about the importance of protecting your bones.

[PMRpro Ambassador in reply to ChrisBeeLoop]

The Guidelines suggest a dexascan within 3 months of starting pred - you need a baseline, you may already have osteoporosis that cannot be blamed on pred.

[ChrisBeeLoop in reply to PMRpro]

That's interesting. My GP was highly resistant to a baseline measurement. Thank you for all this useful information.

[DorsetLady PMRGCAuk volunteer in reply to ChrisBeeLoop]

Why?

Would have thought that a basic for most things -otherwise how do you know if there are any changes -good, bad or indifferent?

[PMRpro Ambassador in reply to ChrisBeeLoop]

Bit of a silly attitude if you ask me - did he think he was paying for it personally? My first was about 2 months after starting pred and showed there was no need to start a bisphosphonate at that stage, calcium and vit D was adequate. The dexa stayed essentially unchanged for over 11 years of pred so no bisphosphonate but I did start a 3 infusion course this spring because an x-ray showed a possible compression fracture on my spine that hadn't been seen before and I hadn't had any new symptoms. But the dexascan was unchanged.

[powerwalk in reply to ChrisBeeLoop]

Yes, my rheumy said no dexa until you are FINISHED pred!!! I'd still be waiting 8 years later if id listened to her!!!

[PMRpro Ambassador in reply to powerwalk]

15 years for me if that had been said! And I have had 5 in the meantime. No problem with the first though - done in my husband's department so no waiting list, As soon as it was requested - done.

[powerwalk in reply to PMRpro]

Really, if we listened to some of these experts!!!!

[PMRpro Ambassador in reply to powerwalk]

It's more the problem they THINK they understand it ...

[Pusph]

Thank you all for your input on my DEXA scan results - I have started taking the Risedronate today.

[DorsetLady PMRGCAuk volunteer in reply to Pusph]

Hope all goes well.

[Grannymiaow in reply to Pusph]

I have taken Risedronate since February as I developed indigestion with AA. No problems at all with the Risedronate. (4 years on Pred)

I have seen the misery that osteoporosis can cause and wish to avoid it.

Good luck!

[yogabonnie]

I improved my DEXA spine score by doing heel drops. No bone AA meds. see YouTube. for bones/heel drops. it improved my spine by 5% over 3 years.!! now in osteopenia from osteoporosis ! hips the same. wrists worse. I should start doing hand stands haha