USAFMOM
07-23-2003, 04:53 PM
I'm 41 and just diagnosed with osteopenia via DEXA scan. (T-scores spine -1.7000, lateral spine -1.833, left hip -1.672, left femoral neck -1.892). My risk factors are family history and small body frame, and I am otherwise very healthy, very healthy lifestyle, and am pre-menopausal. I have lost about 2 inches of height since graduation from high school (22 years). I have yet to see my doctor for this; my appointment to discuss these results is in a week. What prompted the DEXA scan was my requesting one on my yearly Pap exam after hearing what my height was on that visit, and knowing my family history, slight bone structure, etc. I am wondering, on my visit with the doctor, what diagnostic tests are reasonable to expect to have ordered, and what I might want to be sure to ask for. I do not want to come across as paranoid, but I want her to be thorough as I am concerned about other possible underlying causes for this since my risk factors are relatively low, and the doctor herself would have missed this if I had not prompted her. I have chronic thoracic spine pain. If she does not offer, should I ask for a spine series? What about hormone studies, parathyroid levels. Anything else needed or helpful? Thanks!
[This message has been edited by USAFMOM (edited 07-23-2003).]
[This message has been edited by USAFMOM (edited 07-23-2003).]
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bjg
07-24-2003, 08:57 AM
i wouldnt say that yu risk factors are low ..infact just the opposite.i am assuming you are caucasian and that coupled with small frame and family history in my opinion make your risk factors relatively high..since you are pre menopausal you might want to ask your dr about taking actonel ..since unlike fosamax and evista it has been approved for use by women who havent gone thru menopause
USAFMOM
07-24-2003, 09:37 AM
Thank you bjg for that feedback. It will help me when I discuss this with my doc next week. It bothers me that my doctor did not recommend at least a baseline DEXA scan, knowing my height difference, family history, small frame, and Caucasian race. She missed it totally. I'm glad I had sense enough about me to ask about one. Just goes to show that one must not just rely upon the professionals to manage our healthcare, but we must be proactive and aggressive towards our own healthcare. Also, the results of my scan were lost for weeks; I had to call for the results and they had to find them. I was not too concerned actually about the results, and I figured if they were abnormal they would call me; again, I'm glad I had sense enough to call them and not just forget about it until next years exam time. I guess this is why I want to know the right questions to ask, what I should expect to have ordered, etc. etc.
What do you know about Actonel. What makes it appropriate for premenopausal women? I was thinking maybe I could just spend a year with intensive exercise and calcium supplements, check another scan in a year to see how rapid the loss is and go from there regarding any medication decisions. But then again I do not know how severe these scores are for someone my age; alarming, a warning, or no big deal. I guess I will have to rely on my doc to tell me this.
Thank you again for your feedback.
What do you know about Actonel. What makes it appropriate for premenopausal women? I was thinking maybe I could just spend a year with intensive exercise and calcium supplements, check another scan in a year to see how rapid the loss is and go from there regarding any medication decisions. But then again I do not know how severe these scores are for someone my age; alarming, a warning, or no big deal. I guess I will have to rely on my doc to tell me this.
Thank you again for your feedback.
OppOnn
07-26-2003, 09:01 PM
I wouldn't rely 100% on your doctor to tell you. I would want to be proactive and do my own research.
My doctor scared me and told me I should take Fosomax or Actonel.
When I insisted on seeing a specialist who is not just into drugs, but is knowledgeable of alternative options as well, she sent me to a rhuematolgist who said he perceived my DEXA results in a different way and I should not be so alarmed. I was in a panic, in fact.
With scores on my lumbar region worse than yours and no family history.
This doctor and I are trying to do something without drugs, but with calcium and mag. and other minerals, a multi-vit, Vit K, Ipriflavone, and much more excercise, including as much weight baring exercise I can take with my bad back.
I am starting all this mid-August.
He also, by the way, tested my Vit D absorb and it was not good, and I want him to give me the 24 hour calcium urine test to test my calcium absorbption.
And he went over my eating habits with me.
A lot of things can play into results and most radiologists don't factor enough of them into our "image"...like I have Crohn's and this was not considered although it can affect osteo. Thyroid can factor in, and more...
Make sure, also, you go to the same place and machine and, best of all, the same technician for your next DEXA because results can vary otherwise.
I am going to try and solve my bone problems without drugs, and their long term side fx which most doctors seem to ignore.
O
My doctor scared me and told me I should take Fosomax or Actonel.
When I insisted on seeing a specialist who is not just into drugs, but is knowledgeable of alternative options as well, she sent me to a rhuematolgist who said he perceived my DEXA results in a different way and I should not be so alarmed. I was in a panic, in fact.
With scores on my lumbar region worse than yours and no family history.
This doctor and I are trying to do something without drugs, but with calcium and mag. and other minerals, a multi-vit, Vit K, Ipriflavone, and much more excercise, including as much weight baring exercise I can take with my bad back.
I am starting all this mid-August.
He also, by the way, tested my Vit D absorb and it was not good, and I want him to give me the 24 hour calcium urine test to test my calcium absorbption.
And he went over my eating habits with me.
A lot of things can play into results and most radiologists don't factor enough of them into our "image"...like I have Crohn's and this was not considered although it can affect osteo. Thyroid can factor in, and more...
Make sure, also, you go to the same place and machine and, best of all, the same technician for your next DEXA because results can vary otherwise.
I am going to try and solve my bone problems without drugs, and their long term side fx which most doctors seem to ignore.
O
peregrine
07-27-2003, 07:36 AM
Opp,
Did you just recently see a rheumatologist? That is interesting that he/she interpreted them differently! Could you tell me again your hip and spine score? Maybe we're all overly alarmed.
Thanks,
Prema
Did you just recently see a rheumatologist? That is interesting that he/she interpreted them differently! Could you tell me again your hip and spine score? Maybe we're all overly alarmed.
Thanks,
Prema
bjg
07-27-2003, 08:19 AM
according to proctor and gamble the makers of actonel they have done clinical tirals with pre menopausal women with steroid induced osteoperosis and it was fda approved for both post and pre menopausal women .but before you start taking it they recommend a blood test to check for low serum calcium..as for fosamax no clinical trials were done on any one other than post menopausal women so while it is not contra indicated merck the manufacturer says its safety and effectiveness for women who are not post menopausal has not been established.evista which is also used to stop bone loss was also trialed only on post menopausal women and the drug co lily that makes it does not recommend its use by other than post menopausal women...i am very confused about different drs interpreting your t scores differently.i did not think it was something open to debate...
t score of -1 to -1.5 is borderline to mild osteopenia
-1.5 to -2.0 is mild to moderate osteopenia
-2.0 to -2.5 is moderate to severe osteopenia
and greater than -2.5 is osteoperosis
t score of -1 to -1.5 is borderline to mild osteopenia
-1.5 to -2.0 is mild to moderate osteopenia
-2.0 to -2.5 is moderate to severe osteopenia
and greater than -2.5 is osteoperosis
USAFMOM
07-27-2003, 06:19 PM
Wow guys! This info is great! Thanks so much. I didn't even know I could have my calcium and vit D levels checked for absorption. I'm always wondering if I'm taking it right, is it getting absorbed properly to do some good, does it matter if it is with food or without, etc. etc. Nobody wants to be taking supplements if it isn't doing you good because you're not taking it properly. And the classifications on the severity of T-scores is VERY helpful. Thanks again for all of the great feedback!
OppOnn
07-28-2003, 04:47 PM
Peregrene:
Yes, I did see the rheumatologist again. The one who is a diagnostic skeptic! Here's my DEXA results again.
My hip is normal..no osteoporosis.
which my Primary Care Doctor didn't tell me when she first called and said I'd crossed the line into
Osteoporosis and should take Fosomax or Actonel once a week, and sounded so serious I went into a major panic.
My lumbar spine not so good. I have spotty scores - like
L1....T-score... -2.7...Z-score : - 1.0
L2....T-score... -3.0...Z score : -1.1
L3....T-score... -2.2...Z-score : -0.3
L4....T-score... -2.2...Z-score : -0.1
Total T-score... -2.5..Z-score : -0.6
More, not sure now this is all they read, but have not time to do any more now. I did find this already typed up:
Current Lumbar Values: bone density in the lumbar region is currently
0.777 gm/cm2 for a T-curve value of -2.5.
Current Proximal Left Femoral Values: bone mineral density in the proximal left femoral region is
0.836 gm/cm2 for a T-curve value of -0.9.
My new rheumie said I have room to manoevor because my hip scores are normal
and, he says (!) I have actually improved since my last DEXA, but they were done on a different machine (!)
My lumbar average then was - 2.7. Even worse.
I only changed and had more calcium since then.
Only now am I doing and taking more as per my other posts.
I asked my Primary Care doctor why she said I had done so much worse, and she pointed to my bone density scores. He said not to worry. He's the rheumatologist, so I decided to listen to him on this.
O
My Primary Care doctor didn't tell me that!
Yes, I did see the rheumatologist again. The one who is a diagnostic skeptic! Here's my DEXA results again.
My hip is normal..no osteoporosis.
which my Primary Care Doctor didn't tell me when she first called and said I'd crossed the line into
Osteoporosis and should take Fosomax or Actonel once a week, and sounded so serious I went into a major panic.
My lumbar spine not so good. I have spotty scores - like
L1....T-score... -2.7...Z-score : - 1.0
L2....T-score... -3.0...Z score : -1.1
L3....T-score... -2.2...Z-score : -0.3
L4....T-score... -2.2...Z-score : -0.1
Total T-score... -2.5..Z-score : -0.6
More, not sure now this is all they read, but have not time to do any more now. I did find this already typed up:
Current Lumbar Values: bone density in the lumbar region is currently
0.777 gm/cm2 for a T-curve value of -2.5.
Current Proximal Left Femoral Values: bone mineral density in the proximal left femoral region is
0.836 gm/cm2 for a T-curve value of -0.9.
My new rheumie said I have room to manoevor because my hip scores are normal
and, he says (!) I have actually improved since my last DEXA, but they were done on a different machine (!)
My lumbar average then was - 2.7. Even worse.
I only changed and had more calcium since then.
Only now am I doing and taking more as per my other posts.
I asked my Primary Care doctor why she said I had done so much worse, and she pointed to my bone density scores. He said not to worry. He's the rheumatologist, so I decided to listen to him on this.
O
My Primary Care doctor didn't tell me that!