Eileen, do you know anything about the T-scores from bone density scans? I am trying to works it really need to start Alendronic vid. My results are -2.6 neck of femur and -3.5 lumbar spine. Rheumie says this indicates Osteoporosis and I accept that but how bad is it....
This is from the BUPA site:
"Results of a DXA scan
The results of the scan are given as a T-score. This is a measure of how your bone density compares with the normal average for young, healthy adults.
A T-score of between 0 and -1 means your bone density is normal.
If your T-score is between -1 and -2.5, you’re classed as having osteopenia. This means your bone density is lower than normal, but you don't yet have osteoporosis.
A T-score below -2.5 is classed as osteoporosis.
If your T-score indicates that you may have osteopenia or osteoporosis, your GP will give you advice about treatment options. You may be referred to see a specialist, such as a rheumatologist. Your GP will consider both the T-score and other risk factors when he or she gives you advice about treatment to help prevent fractures."
Those results you have quoted are decidedly into the osteoporosis level, the lumbar spine one is very far in. Lumbar spine often tends to be a bit worse than the hip. Those are results that would convince even me to discuss medication with my doctor. What has he suggested?
Thank you Eileen!
The Rheumie wanted me to start Alendronic Acid last year, but I have a problem with a tooth that a previous dentist tried to do root canal work on but couldn't manage it. There is therefore the possibility of it having to be removed in the future and I was worried about being on AA. So, I only took it twice and have been waiting to get these results to see if I am actually into the realms of Osteoporosis.
Ach! These are not the results I was hoping for. All the worse because they were from last September when I had been on Prednisolone for only 2 months, so I must assume that the steroids have made them worse by now. I don't know how quickly they do damage.
My vitamin D result came back today. It's 53 which seems to be a bit low from the figures I have seen.
i suppose I must take the AA.
A dentist I saw last week made it clear he would be unhappy considering an extraction if I've been on AA. Don't know what to think because I'm not having the tooth out in the near future.
Discuss the tooth with your dentist - at length. Does it need removing? What are the chances of it needing to be removed? Because I don't think any rheumy will be too happy at you not taking some medication with readings like that. If it is any consolation - I doubt the entire damage was done in 2 months of pred. Your osteoporosis was already there and should really have been identified earlier. The densities don't change overnight, the majority is felt to happen in the first few months so that should be a baseline but it takes months for significant changes to be identified. Even when on pred, according to the rheumy who refused me a second dexascan jsut a couple of months before the 2 years was up!
I wonder if your doctor would consider the teraparitide - it has been used to treat osteonecrosis of the jaw which is the fear on the part of dentists I think in relation to bisphosphonates. And your lumbar reading is pretty low.
Thanks Eileen
rheumie signed me off and told GP next scan in 5 years
Eileen do you think it's possible to increase bone density naturally through diet and exercise? I definitely have steroid-induced osteoporosis but am now down to 3 mg pred and hoping to come off it altogether in a few months. My feeling is that if you can only be on biphosphonates for five years anyway and I am only just sixty I could try natural methods for two years and if there is no improvement start taking alendronic acid then. I just hate the thought of an alien substance in my bones which will be there for life...
I'm surprised when they make such a fuss about people taking the stuff when their scans are far nearer normal than that - but also very pleased for you. If you are on pred I understand it should be 2 years though. How all very strange - why did your GP waste and appointment to "discuss" it?
It is - nordic walking has a good record I'm told and can actually be associated with an increase in bone density. The main problem is that at our age it is difficult.
However - there is some dispute as the the value of increasing the bone density. Low bone density ISN'T necessarily associated with fractures, people with normal readings can have fractures, people with low readings don't always do so. It is avoidance of other risk factorsthat is important - which I've preached loads of times about! Rugs on slippery floors, trailing cables, poor lighting, handrails on stairs, wearing shoes not fluffy slippers in the house, keeping muscle tone and balance good and BP in a good range (i.e. not overmedicating on the ground very low is good), keeping hydrated and keeping vit D at good levels all contribute. I'm sure there are others I haven't mentioned.
Needed the Rheumie to diagnose me. The GPs said it wasn't PMR. She also had to give me a useless tapering schedule....
Dinah, are your results similar to mine? I too have been worrying about taking AA? I will speak to my GP next week, but I have a pretty good idea what her response will be...
About 'it being difficult for people our age' Eileen. Do you mean to do the Nordic Walking or do you mean increasing the bone density?
i raised that with GP when I went back to see her after Rheumatology and she said that 2 years would be too soon, that the changes wouldn't be evident by then.
i decided that if I was off steroids within the 5 years I would discuss stopping the AA, but I don't really know if that's the right approach.
oh dear, it is so difficult...
Hi Sheila - yes my results are fairly similar. When I had scan two years ago, having been on steroids for a couple of months I had ostopenia in hips and legs and osteoporosis (-2.6) in spine. On my last scan a month ago the ostopenia had progressed to osteoporosis (average -2.2 in hips from 1.2 previously) and my spinal score had increased to -3.1
My Exeter rheumatology had said there was "no point" in having scan after two years as results weren't reliable. But the first thing my new consultant said at Guys was that as I had been on steroids for over 18months I should definitely have another bone density scan, but that it was important for it to be on the same machine. So my GP organised it, no problem. I think you should be fairly insistent with your GP about it.
Re alendronic acid - I saw one GP who was sympathetic to my feelings and agreed that if I was off prednisolone there probably wouldn't be too much change so I could try diet and exercise and then have another scan. But that I should make a "positive" decision either way. The GP I saw this morning felt I really should take the alendronic acid. I am going to ask my consultant's advice at my appointment in a couple of weeks.
I have to admit I did fall and fracture my wrist in January - but I fell really heavily on to my outstretched hand and my son, who is a doctor, said lots of people without osteoporosis break their wrists in that situation.
Hi Eileen. I had a Bone densitronomy DXA scan 2nd Feb 2015. Because rightly or wrongly I thought that after 4yrs. I had been on Alendronic Acid for long enough and stopped taking it 3 months ago.Saw my GP this morning to "Discuss scan report", his wording. He is as confused as I am and suggests that I see my rheumatologist for a clearer explanation of 'T' and 'Z' scores. I see RH in about a months time luckily. In the meantime herewith a brief rundown of the figures from the Consultant Radiologists report. Do you know what a 'Z' score is?
Lumbar spine:- T Score 7.7 Z Score 9.0
Left Total Hip :-T Score 1.5 Z Score 2.6
Given the above results the patient has Normal Bone Mineral Density.
The report finishes with "WHO criteria for BMD interpretation classify male patients as Normal"
So I guess that as an 82 yr. old male I am 'Normal'.
I would be very interested to know your thoughts on these scores.
Regards.
JanaPea
From my research recently, T scores are compared data to healthy adults and Z compared with older people.
That was all so helpful Dinah. More food for thought. Could wish this had been an illness that didn't require soooo much thinking, researching and deciding. However, as we keep rightly saying it could be worse, it is not terminal and it will all eventually pass...
Eileen I don't suppose you know how AA works? How does it know where the low density areas are?....
Sorry - I clicked post and then realised it wasn't clear but OH decided he wanted to go out for lunch so I rushed away.
Building bone density - it can be done but is likely to be harder to do enough weight bearing exercise and the metabolism is different with the lack of oestrogens etc that also help build bone. That's part of why it becomes a problem post-menpause. The bisphosphonates don't build more bone, they just slow loss while bone is still being created. Only Forsteo actively builds bone.
Nordic walking courses are sometimes offered by AgeConcern and other groups like that. I'm waiting for NordicWalking UK to get back to me (ever the optimist, they called me while I was standing in a hospital ward waiting for my husband to be discharged, could she ring in a hour I asked, that was fine she said. Yeah right) but if you google them you'd find info about where you might find courses.
It doesn't I don't think, it doesn't preferentially increase bone where it is needed as far as I know. So I assume decent bone gets denser and not OK bone gets closer to being OK. If you see what I mean.
Bone isn't a static substance - it is continually being broken down and rebuilt. This explains it quite well in ordinary language:
Um - earlier than 2 years is too soon but 2 years is more usual than 5 years. Where did you find this GP? I'm having my faith in the NHS and doctorsin general sorely tried today (not just you).