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sbncmo posted:
About 20 years ago, my doctor ordered x-rays & the radiologist said there were pin-point holes in my bones, the beginning of what he believed would eventually be osteoporosis & he told me to start taking calcium with vitamin D. A few years later I had to change doctors because he moved. I've stayed on the calcium with vitamin D all these years - I'm limited physically due to a major back injury & other health issues, I'm lactose intolerant, I have asthma & epilepsy so I have meds that affect the bone density, in short, I have a lot against me. The good things are I've never smoked, drank alcohol or soda, & I eat lots of green vegetables.

My current doctor said she did a bone density test last year & she just did another one this month. Well, I have never had one done before like the one I just had. I don't remember her doing one last year & never heard any results from one being done last year. The results of this one are that I have osteopernia. I don't know the severity of it yet & will be seeing her soon to discuss it. I'm sure the calcium & vitamin D has helped. (I also have osteoarthritis hitting big time & my fingers are starting to twist like pretzels, all my joints hurt terribly, feeling bruised - even my toes. I don't think they are related.)

What I don't understand is how my doctor could say she did this test last year & me not remember it. Was the type of test changed? For the test this month, they took several pictures while I was on my back, then I had to lay on my side with my back against a board with nothing in front of me to keep me there. I kept digging my fingers into the vinyl table top to try to stay in place & with back injury & other problems, it was torture. Believe me, I would remember if I had had that done last year. So, was the method of testing changed or is it possible that our area just hasn't caught up to new technology?

I'd appreciate anyone's input.

Shelia
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Tomato05 responded:
Maybe the doctor is mistaken - you could ask to see the results of the "previous test" and if the doctor can't show you those, you can then confront her again.
 
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sbncmo replied to Tomato05's response:
I would have considered that, but she actually looked back at my records from last year when she was saying I had it done then & needed to have it checked again. All I know is I've never had a bone density test like I had this month. That's why I was wondering if the method of testing might have been changed.
 
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bonebabe replied to sbncmo's response:
If you had a DXA scan, the testing procedure has not changed. I've been doing this for 16 years in an accredited osteoporosis center and have never heard of a test where you lie on your side. You lie on your back and your lumbar spine and hip are scanned. Sometimes the forearm depending on your spine and hip results. Also the doctor can order a Vertebral Fracture Assessment which looks at the entire length of the spine laterally. You still lie on your back, but your arms are raised above your head.

Also, she may have pointed out that if you have arthritis in any of the scanned areas, it can artificially elevate the test scores.

While your diet over the past 20 years is to be commended and is certainly beneficial, osteopenia is a vast gray area and one shouldn't feel like a bullet has been dodged simply because there is no diagnosis of osteoporosis. The real issue you should be looking at, rather than T-scores, is fracture risk because the whole goal of bone density testing is to prevent fractures. Ask your doctor what your fracture risk is based on either FRAX or the Canadian model. If your risk is high, you should probably have a conversation about medications.
 
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sbncmo replied to bonebabe's response:
Hi bonebabe,

The DXA scan sounds a little different than what I had. The first pictures were while I was on my back. One set of pictures was taken while I was lying completely flat, then another was taken with my lower legs elevated on a foam wedge, then another was taken of my hips by forcing my my legs into a certain position with some contraption & velcro, then the final one with me on my side. I never had to raise my arms.

I fell & compacted my lower spine 26 years ago & was treated by a chiro. I had x-rays taken by another chiro 5 years ago because I was in such pain & PT/meds didn't help. I asked my doctor to order the same x-rays. In those x-rays taken a few months ago, the techs couldn't distinguish any of the damaged bones anymore, so they wouldn't even send it the radiologist. They moved the focus of the x-ray 7" higher & the report said I was normal. I am in hopes that this bone density test will also show the condition of my back injury. I don't know, maybe she was checking it as well. Having me lay on my side just doesn't make sense.

I just had a fasting Vitamin D test run & haven't heard any results. I know there must be some concern, because even though a doctor's nurse can't tell a patient anything until the doctor says to, when my doctor's nurse called last week to tell me about the osteopenia & I told her I had fallen 3 times in less than 2 weeks, she became very concerned & said I may need to consider talking to my doctor about having someone with me all the time. So, she had the numbers in front of her & it was enough to raise concern. But I'm not going to jump to conclusions. I'll wait until I get all the results back & talk to my doctor. My nurse basically said the same thing you did about osteopenia - it doesn't mean I'm safe.

I have written down the words "fracture risk", "FRAX or Canadian model" to ask my doctor about when I see her. That will help me a little. I'm sure she will refer to T-scores. I don't really know what any of it means. If you don't mind, maybe you can educate me a little.

Thanks for your help. I wish we could figure out the side-view x-rays. Maybe my doctor will explain. Thanks again.

Shelia
 
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bonebabe replied to sbncmo's response:
I was with you until the side view. It may be that the DXA machine was an older one and they were doing a vertebral fracture assessment. I just don't know.

I'm astounded that the rad techs wouldn't send your x-rays to a radiologist. If the techs could make all the determinations by looking at the x-rays, we wouldn't need radiologists. I hope you didn't get a bill for an interpretation.

Your fracture risk is what you want to know. FRAX is computed when you have osteopenia and are NOT on any osteo medications, including hormones, or have been off for 2 years. The Canadian model is used for all others. Since the purpose of bone density testing is to reduce your risk of fracture, you need to know your risk.

I wouldn't stress about the Vit D. Most people are low. It's a simple fix. Vit D has shown in studies to be beneficial in improving balance, even in people in their 90's. Since you've fallen several times, a balance assessment and possibly a physical therapy home visit to assess your hazards there would be a good idea.

I'd suggest that you become familiar with the National Osteoporosis Foundation website - www.nof.org . There you can find good, easy to understand, reliable, tested information. The FAQ section is especially useful.

I hope this info helps some.
 
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sbncmo replied to bonebabe's response:
Thanks, this is helpful. The FRAX is what I will need to go by since I've never been on osteo meds & went off hormone meds years ago.

I don't know about a bill for all the x-rays the techs said couldn't be read. If there was one, it was sent to my insurance. I did go & get a disc copy of the x-rays sent to the radiologist & they were not images of the area I requested. But, again, maybe the bone density will show how all the lower bones are melded together.

I keep things simple in my house & as hazard-free as possible. I'm already using a rollator & my spine injury is causing increasing spells of temporary paralysis, so I've had to make it safe. But we are making even more changes because a wheelchair may not be that far off for me.

I'm going to look at the NOF website. I like easy to understand & reliable information. Thanks for providing it. You have been a great help.

Thanks again,
Shelia


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