DEXA and Leaky Bowels

[ChrisBeeLoop]

Two questions for my knowledgeable chums.

I was diagnosed in November 2023 and after a battle with my GP managed to get a DEXA scan in early April. Results are that this 75 year old has the typical bone density profile of a 30 year old. Yay! Is it reasonable to push for another scan after 6 months or should I wait a bit longer before embarking on another round of debate with my GP? Is it worth asking for a Vit D blood test with my next CRP test?

I have had ongoing problems with leaky bowels which seem to be getting worse. My GP arranged a FIT test which was negative but another test showed a high level of Faecal Calprotectin Content (249ug/g). I have a phone appointment booked for Monday. Any advice on questions to ask and tests/drugs to request? The only drugs I am taking are 5mg Prednisolone, 20mg Omeprazole and Calcichew Vit D. I have read that Omeprazole can cause stomach inflammation.

[PMRpro Ambassador]

I think it depends a bit WHY your bone density is so high. Are there any lesions suggesting you may have arthritic bone that is more dense and giving a falsely high reading? Or, like a friend with similar results, have you been on HRT for a long time? My bone density wasn't exactly that of a 30 year old - but it was pretty good and I put it down to 13 years of HRT. The PMR appeared about 6 months after I stopped - was there a link there? But I was only in my late 50s at that point, the friend though was in her late 60s I think.

Why would you want another DEXA? Bone density doesn't usually change fast - and you won't be allowed one on the NHS, it will almost certainly be denied. It is always worth knowing your vit D level - it is done annually here I think. I assume you are trying to avoid bisphosphonates? But there are cases where spinal compression fractures develop despite good DEXA results. I have had one and had an infusion at the start of the year. tangocharlie has had a lot of trouble and several fractures which she has written about

Sorry - what do you mean by leaky bowels? There is obviously inflammation and long term use of PPIs can possibly lead to inflammatory bowel disease - it is disputed/debatable. But the person to ask there is the GI specialist.

[piglette]

In my area you can only have a Dexa scan every three years.

[tangocharlie in reply to piglette]

Same rule around here

[pmr_nikola]

congrats on good results from DEXA scan. I got the same results ( good bone density) but I attributed that to lifetime exercise.

On Omeprazole - I am surprised that you are still on it. Usually it is used at higher doses of pred. My doctor discontinued it as soon as I was below 10mg . Also my experience was that Omeprazole caused me all kind of stomach issues ( as you are experiencing now). Taking pred with some yogurt may be sufficient to prevent damage from pred to your stomach lining.

[tangocharlie in reply to pmr_nikola]

But I had a good DEXA result yet still had spinal fractures as I've mentioned in other posts. DEXA is only one part of an overall risk assessment (you can do a FRAX test on the ROS website). Then it's an individual decision whether to rely on diet and exercise to keep your bones healthy or take some kind of bone supplementation and there are lots of options, from tablets like Alendronic acid to annual infusions. Re the Omeprazole it causes problems for many people, I can't tolerate it at all, and like you say, according to the talk given by Dr Christian Selinger in the AGM a few weeks ago, probably not needed on low doses of Pred, eg below 10.

[pmr_nikola in reply to tangocharlie]

Good idea to get "second opinion". I went to

Fracture Risk Assessment Tool - FRAX - University of Sheffield and did FRAX Assesment.

Results are that I have 3-5% of developing Major osteoporotic and 0.2% of hip fracture in next 10 years. I never ever, ever broke any bone in my body and I do push the boundary. For example: couple of years ago I hit wild goat while mountain biking and flu over several meters before landing in the ditch .

[tangocharlie in reply to pmr_nikola]

I did the frax assessment and came out as low risk even though I take steroids. BUT I have spinal fractures so I am high risk. The risk assessment 'system' let me down. 'Lessons need to be learned' somehow

[ChrisBeeLoop in reply to tangocharlie]

The FRAX assessment is a bit of a blunt instrument. It gave me a 15% chance of broken hip, then I reduced the amount of wine I said I drank and it came down to 7%. Not enough questions to really dig deep. Also, if I were 100% fit and healthy, there would still be an actuarial possibility of a broken hip in the next ten years. So what is “normal”?

We need more info on how our bodies look. We should be offered scans rather than have to fight for them. Prevention is better than a cure.

[Pippah45]

I was given a second Dexa scan after 3 years so I am not sure you would be allowed one after a few months when all was good.