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Quality versus Quantity
megmo84 posted:
Hello Everyone,

I've been recently introduced to the notion of "bone quality versus bone quantity". At 26, I have severe osteoporosis in the spine (T -3.6) but have never had a fracture. (My osteo results from an eating disorder I developed at age 12.) I am currently on Forteo, do weight-bearing exercise, and eat a bone-healthy diet. As I think of my course of future osteoporosis treatment (i.e. resuming bisphosphonates), I wonder if I am actually in as high a risk of fracturing as my T-scores imply. After Forteo, would medications do more harm than good? My research tells me that DEXA scores tell only part of the story.

Thanks in advance for your insights.
bonebabe responded:
First the good news - you don't have "severe osteoporosis" because you've not fractured. Severe osteoporosis is defined as having a T-score of -2.5 or lower combined with the presence of at least one fragility fracture. What you have is plain old osteoporosis - provided you're postmenopausal. If you're not postmenopausal, you have low bone density for your age group.

Now, quality vs quantity. You're absolutely right about bone health being more than a T-score. The object of DXA testing is to reduce fracture risks. Other things come into play, such as balance, other meds being taken, alcohol consumption, prior fractures and age. An older person with the same T-score as you certainly will be more like to fracture and have a longer recovery period than you would.

We also take into account your FRAX score. That's a tool used to predict fracture risk over the next 10 years.

It sounds like, with your eating disorder, you've never reached your possible peak bone mass. Being on the Forteo is good because it will grow new bone. The bisphosphonates will strengthen that new bone. It may be that after a couple of DXA's where you haven't lost any density, your doctor will take you off the meds to see how you do. And remember, it's the not losing that's important. Gaining or staying the same is considered good.

It's very important that you get in your 1200 mg of calcium each day. Spread it out to no more than 600mg at a time to maximize your absorption. also you need about 1000 IU of Vit D each day.

I'd also get some instruction in good body mechanics to reduce your chances of fracturing. It's those everyday repetitive movements we do that wears down the bones and can cause them to fracture.

You've got a lot of years ahead of you. It's wonderful that you're taking proactive action now.

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