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Significant Differences in BMD
megmo84 posted:

Disappointing results after 2 years of Forteo[a> . I've listed my BMD[a> as well as my Z-scores (I'm premenopausal).

AP Spine
1/5/12 0.762 g/cm; -2.5 (Z-score)
11/24/10 0.810 g/cm; -2.0
2/2/10 0.752 g/cm; -2.5

Dual Femur (Neck Left)

1/5/12 0.839 g/cm; -0.7
11/24/10 0.795 g/cm; -1.0
2/2/10 0.825 g/cm; -0.8

Dual Femur (Neck Right)

1/5/12 0.835 g/cm; -0.7
11/24/10 0.882 g/cm; -0.4
2/2/10 0.897 g/cm; -0.3

Dual Femur - Total Mean
1/5/12 0.779 g/cm; -1.1
11/24/10 0.847 g/cm; -0.5
2/2/10 0.852 g/cm; -0.4

Are these results significant? I recall the topic of significant differences being addressed before, but can't find the thread. Not sure how to feel... Trying not to get discouraged.

Thanks in advance.
Tomato05 responded:
Yes, you must be disappointed indeed. It doesn't seem as if Forteo has helped you much.

I suppose you are going to discontinue it now?

Maybe just continue to take calcium and vitamin D, and exercise really intensively. It has worked for me, but then, I am also taking strontium. My previous bone density test (1.5 years ago) showed quite an improvement.

What does your doctor recommend that you take from now on?
megmo84 replied to Tomato05's response:
Nothing. I've tried a series of bisphosphonates and 2 rounds of Forteo. He recommends the usual calcium plus D and weight baring exercise. Perhaps his most notable recommenation -- weight restoration.

Though I'm now in recovery, an eating disorder I developed at age 12 resulted in fifteen years of abnormal menses. I've used birth control pills as my estrogen source. Looking back over the last two years, I suppose I've lived with a false sense of security thinking that Forteo would be my saving grace. Now I realize I must continue to focus on reaching a more normal BMI.

I also remind myself that I've not yet fractured so hope is not lost. Bone Babe often reminds us that the T-score is a marker of osteoporosis, but doesn't doom us to broken bones. I'm tempted to frame her words on my wall!
Tomato05 replied to megmo84's response:
Yes, a more normal weight would definitely help. Add a few high calcium snacks like yogurt, nuts, cheese, etc. Ice cream has calcium too!

Yes, you are still not in a desperate condition, so work hard to maintain the bone you have.
megmo84 replied to Tomato05's response:
Thanks for your affirming words, Tomato
bonebabe responded:
Not disappointing, you're stable. From 2/10 to 1/12 (two years) your scores are basically the same. Pretty good. I know you probably wanted to see a big improvement, but not knowing what's causing the bone loss, it would be hard to say.

What you're looking for is the LSC - Lowest Significant Change. At our center it's 0.278 for the spine and 0.279 for the total hip. You get that number by doing a precision study on the DXA machine. That involves putting 30 people on and off the table twice to see how closely the tech can duplicate the scan. The difference, after a bunch of calculations, is the lowest number where a change would be considered significant. Each testing center will have their own result. So ask at your testing center what their LSC is. If they don't know what you're talking about, I'd pay out of pocket for a test somewhere else that's accredited, especially with the Forteo treatment concluded. Even the tiniest bit of variance in positioning can make a HUGE difference in your scores. You want the best test possible.
megmo84 replied to bonebabe's response:
I've never heard of the LSC. Will definitely ask. Thanks Bone Babe!

Also, my rheumatoligist focused solely on the T-scores when reviewing my results. I thought the Z-scores were the ones to watch since I'm pre-menopause. Am I missing something?
bonebabe replied to megmo84's response:
It's the BMD that is used. T-scores and Z-scores are not accurate in reporting change. If you had your test done at the same place, the scan software itself should show the change. For a doctor to simply look at a Tor Z-score and determine change is not fair to you.

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