My mom who died at 93 in 2021 had dexa scans. The late-1990s were 25 years ago, so it surprises me that your relatives weren’t offered scans.
My mom had the scans, too, but my MIL (97) has never had one. Like everything else healthcare related, it depends on your doctor.
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Me too! Surprised! I don’t know if it was because she was super active or what.
I had to ask for a dexa scan at 59. My PCP said that they didn’t do them until 65 which I thought was too late.
I suspect it’s because of Medicare and living in a poor community. I also think that my former PCP who retired didn’t prescribe tests like my new younger female PCP.
I had my first scan and I was told I have osteopenia, the second said nothing changed so I’m off the hook for now to start medication.
I think osteoporosis medication is like medication for high blood pressure. I resisted taking any hoping I could make changes myself. Didn’t change so I reluctantly went on medication. I don’t see any change from my day to day but am sure it is beneficial in the long run.
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I live in a major city and my PCP is affiliated with a big teaching hospital. I am 60 and she also recommend I get my first dexa at 65 since she doesn’t feel I have any risk factors. No family history, no fractures, healthy/no meds eat well and get lots of exercise. My niece, a health care provider, sent me this article to confirm what my PCP was telling me. After reading here I was surprised at how many of you had had dexa scans prior to 65.
So, for now I’ll just wait but thought I would share the article in case it helps anyone else.
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Interesting, @leftrightleft. Some other articles I’ve read show additional risk factors for osteoporosis - including being of Northern European or Asian descent and having a low BMI and being athletic/not eating a lot when younger.
I had each of those factors (no others) and when asked for first Dexa when I was about 56 - had both osteopenia and osteoporosis.
So it seems like there are a variety of opinions as to when/what factors to consider when getting the first scan. My sense has been to err on the side of caution and request earlier…
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This is me. I’m on my feet 8-10 miles a day. I am not small boned and thin. On paper, the only “risk factor” was earlier menopause. A very easy menopause with no issues, no meds.
But the numbers don’t/didn’t lie and they barely improved over several years with even more effort.
You really don’t know unless you have scores in your hand.
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I understand! I posted the article and tidbits of my discussion w/my PCP because I, like others, questioned the recc age of 65. I’ve checked with my friends in various parts of the country and they’ve heard what I’ve heard. Everyone needs to read and question and make their own decisions.
Appreciate everyone sharing so much info.
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I’m a doctor in my early 50s, and I have a lot of doctor friends my same age. Those of us without risk factors plan to wait to screen until 65, but we plan to treat immediately when that DEXA comes back saying osteoporosis.
We figure what is the point of testing earlier, often repeatedly, but doing nothing about it? (Added calcium, vitamin D, weight lifting etc do essentially nothing.)
When we finally do do the DEXA at 65, we won’t be surprised when the DEXA shows osteoporosis— we will be surprised if it doesn’t. No amount of virtuous living erases the fact that most women develop osteoporosis.
Those of us with subclinical eating disorders will get tested earlier. A lot of women have subclinical eating disorders (chronic dieting or overexercise) but don’t realize it because in our society women get huge amounts of praise for these behaviors and are told they are extra healthy. But these behaviors unfortunately are a huge risk for early onset osteoporosis.
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This is a really interesting take. I am sort of what you described…probably 3 or 4 dexascans starting in my 50’s that I decided not to medicate but to try “lifestyle changes” - finally started taking Prolia at 64.
Do you know a % of women who develop osteo or penia 65 or older? I’m just curious.
And your last paragraph is quite interesting. Haven’t really heard that before.
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I never thought I was at risk for osteoporosis–sturdy build, no family history AFAIK, etc. Then I had a fall in my fifties, fractured my humerus and the doctor suggested that I get a bone scan. It turned out that I did have osteoporosis. I had been on Tamoxifen for five years, and I learned that in premenopausal women, the use of tamoxifen causes systemic estrogen depletion, which has detrimental effects on bone health.
The studies are very annoying because they will often lump all women over 50 together. Or lump men with women. Or not break out by race. Or lump nursing home residents in with those still in their own homes. But anyway, the study that I keep in my head showed 86% of white women 85 or older had osteoporosis, and only 3% at that age had normal bone density. Maybe people figure that at that age they won’t care anymore, but spine compression fractures especially are super painful.
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@gotham_mom I took an aromatase inhibitor for 5 years for cancer, which depleted any remaining estrogen (from adrenals) post menopause.
I thought tamoxifen only affected estrogen receptors, not estrogen levels in the body, and that a related medication, raloxifene (Evista), is even used to treat osteoporosis. Both are SERMS.
Tamoxifen and raloxifene are both selective estrogen receptor modulators (SERMs). The medicines can block estrogen mediated breast cancer growth and development but will also maintain bone density in postmenopausal women and lower circulating cholesterol. SERMs for the treatment and prevention of breast cancer - PubMed
SERMs for the treatment and prevention of breast cancer - PubMed
@abasket what will you do after Prolia to avoid the severe rebound? Or will you take it for the rest of your life? My doctors at a major teaching hospital don’t use Prolia in their practice unless absolutely necessary. The rebound is a concern because it can make bones worse than when you started, unless Reclast is taken (or Fosamax if only 1-3 Prolia shots were taken).
Decisions are so different for those with early osteoporosis versus those with more severe numbers. Keith McCormick’s book “Great Bones” is a great resource for both. Many with early diagnosis can stay stable for awhile without meds but for any score below -3.3 or even -3.0 even McCormick says meds are needed.
The thing is, all meds have time limits and doctors don’t seem to know what to do long term. Bisphosphonates 3-5 years, Tymlos 2 years, Forteo now a little more than 2 but not that effective at that point, Evenity one year. Prolia has a longer time span but is problematic. So if we start meds early, what happens over time when all those time limits are used up? Then again, waiting, as I did (partly due to COVID) means fractures since there are no symptoms.
Sequencing is important too. Bone builders like Tymlos, Forteo and Evenity work much better if a bisphosphonate or Prolia was not used [previously. This may not matter to those with mild osteoporosis but it is very important for the rest of us. Insurance requires the cheaper anti-resorptives first which needs to change. Dr. Ben Leder has a great video on this on YouTube" “Combining and Sequencing Approaches to Osteoporosis.”
DEXA’s are important but many people also have bone marker testing (CTX and P1NP) to see what bones are doing. My docs don’t do them though- they say they don’t give enough info on what is going on in bones. The Mayo Clinic osteoporosis forum discusses bone markers often, as a guide to treatment. Something else to consider.
Along with DEXA people are doing a TBS evaluation (apparently available with some DEXA’s). Trabecular bone score measures quality and DEXA measures quantity. I don’t do TBS because with 7 spinal fractures- well, it’s kind of obvious what the results would be.
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Weight lifting made a dramatic difference for me. I started when I was around 56 and it definitely increased my density, as shown by my test results. (I don’t remember the numbers, but I remember my endo cheering me on and saying, “You’re the poster child for weight lifting!”)
That said, I do think there’s a point of diminishing returns. I still lift heavy things over my head, but also get Prolia injections every six months.
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I think this makes so much sense. I assume as medical professionals you would already make sure you got sufficient calcium and vitamin D in your diets.
One thought, the one thing I do since diagnosed that you don’t mention, is avoid putting pressure on my spine. So, no forward folds in yoga, etc. Do you just stop doing that when you turn a certain age anyway, just in case?
Oh my, I do all of that stuff. I figured it was stretching out my back and keeping me “long.” (Hah. I’m 5’0" on a good day.)
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I was doing yoga before my diagnosis and changed to only half fold, etc. since being diagnosed. It is pretty well documented on all the osteoporosis sites, yet, many don’t know about this recommendation. Some endocrinologists don’t mention it to their patients.
Stretching is fine, but not stretching that puts pressure on your lower spine. I am down to just over 5 feet on a good day - probably 1 1/2 inches shorter than my best height - so I totally get wanting to be longer!
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You are much more knowledgeable than me. I’ve done a quick search, and it seems that there is conflicting evidence about increased risk for osteoporosis in perimenopausal women diagnosed with DCIS who take Tamoxifen (exactly my situation). I’m taking meds and Calcium w/Vitamin D, plus increasing my weight-bearing activity. I hope this will improve my numbers.
I know you have very strong feelings on the various methods of treating osteo. As I’ve said before I won’t get into defending my choice of meds here or deeply explaining my personal health situation and decision.
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