How accurate are the bone density tests?

I am a new member to this wonderful site. Thank you all for caring and sharing.
I am 59 and have had osteo for maybe 8 years now.
My MD never seems too knowledgable or concerned with my scores. The T-score on my spine was -3.7 in 2003, -3.5 in 2004, -4.1 in 2007 and now last month it is -4.3. When I was first diagnosed the MD put me on Evista. Later I saw a rhuematoligist and he added the Fosamax along with the Evista. At some point my co pay was too much and I dropped the Evista. After my last test I decided to see another rhuemie and he was more interested in why I quit the Evista than why my score is so low. He said there is margain of error in the tests and maybe it is not accurate. I asked about the Reclast and he said it is the same as Fosamax except it is once a year instead of weekly. That was news to me! He wondered what my concerns are because I have not been experiencing any fractures. I explained to him that I hope I never do and would sure like to improve my scores and prevent any fractures in the future! I felt as though I had more info than he did, thanks to my own research and this site! Then I asked him if maybe I should consider Forteo. He said we could consider it BUT it cost $1000 a month and they would need to submit forms to see what my insurance would pay and see IF I could afford it! IN the meantime I should continue the Fosamax. I then asked if BY CHANCE he had any samples as I had just taken my last one and did not want to refill for a 3 month supply for one or two pills. He said they did not have any samples and wrote me a new prescription for the Fosamax. I was so totally disgusted and do not think I should go back again. It has been a week and I have not heard from them about what they found out about my insurance covering the Forteo. I felt like I was whining for
some minor thing and that my osteo is not that bad even though the test says I am at high risk for fracture of the spine. My hips have remained about the same with T scores of -2.4. I do a lot of walking so I'm not sure if that helps or if the Fosamax has helped some. I am not sure what to do next. Any suggestions?

By Blues
Posted August 11, 2008 at 5:05 pm
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I get my Forteo and other meds. from Medco (that is who my prescription plan uses) and as a member I can log on and price a drug. It will tell me how much I will pay and how much my plan pays. Does your insurance have a website where you can log on and check for yourself? The total cost to my plan and me is approx. $2700.00 for 3 months. I have seen posts from other people who have gotten a better price.

By windblown
Posted August 11, 2008 at 5:06 pm
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Hi momram: Welcome to the community... If you are interested in Forteo, couldn't you just call your insurance co and ask if it's covered, and if so what the copay price is. I took Forteo for 2 years, and my Dr didn't have to submit any forms other than writing a rx for Forteo after I found out if they paid for it. There was a form that was filled out for the ins co, but it had something to do with having the med delivered via FedEx.

I had taken Actonel for a little over a year and my score went from -3.6 to -3.4 (with frax's years before) so when I found out that my insurance would pay for the Forteo, I went on it. I made all the phone calls, my Dr didn't, but maybe it has something to do with the insurance co you are dealing with??

You have taken a bisphosphonate (fosamax) and your score has gone down so Forteo *could* be an option for you. It is very expensive, so finding out if it's covered is really important.

Dxa scores alone do not predict frax's, but I think your score is such that anyone would consider trying Forteo. Of course this is your decision, and I don't really believe your Dr should dissuade you if that's what you want to take.

My t-score is now in the normal range, so I did really well on Forteo. I did have trouble with the cost; the insurance co changed the tier level on it after the first year, and it went from a $60.00 copay to 175.00.

If you aren't happy with your Dr and your insurance will let you change to someone else, I would look for someone who is more considerate and knowledgeable.
University Med Centers have specialists in Osteo if you live near one.

There is a margin of error on dxa's but I'm not exactly sure what the Dr is trying to say. Is he/she implying that your lowering score is within that margin of error? Read what the NOF has to say on margin of error for dxa's; I believe they are around 3%, but be sure to verify that.

Walking is good exercise, keep that up and read about the other things here that are suggested for weight bearing exercises, by our PT's and other Health Professionals under the exercise threads, because you also need to consider safety as well as exercise.

Reclast is a bisphosphonate like fosamax, however it's administered by infusion so it doesn't cause the gastro intestinal probs that the oral med sometimes does. If you are interested in that, you should be able to decide that as well. Since Reclast is given once a year it is a stronger nitrogen containing form of bisphosphonate, so do reading on that.

If I had to deal with a Dr that didn't put my feelings/concerns first, I couldn't stay with that Dr. You'll have to decide what to do, but in the mean time I don't see any reason why you can't call the insurance co and ask about Forteo, and Reclast if you are interested. Take it one step at a time, and if there is a problem with the insurance co not covering Forteo, please post back, since there are some options on that.

Good luck...

By windblown
Posted August 11, 2008 at 5:28 pm
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Hi Momram: I forgot to mention, that when I call my insurance co they have an option that says you are calling from a pharmacy. If they have that, push the appropriate number, it's no problem. Also, like Blues said, you can look it up on line. My insurance has the same feature where you can price a drug and see if it's covered, also they give you a list for all purchases placed for the year so you can keep track of your rx's. I recently talked to a pharm distributor, that covers specialty meds (Forteo) and they charge a whole lot less than what I paid, and it isn't based on income, but on whether your insurance covers it or not; so there are several options available that we have all looked into at some point in time.

Good luck..

By Pamela2
Posted August 11, 2008 at 8:06 pm
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Hi, I know how costly the medications are, but I take actonel and they have a web site that gives you a form to fill out and for each perscription you fill they reimburse you $20.00 which I think is really great!
You just need your receipt from the pharmacy. check the pharm. website and see if they offer any rebates as well. I feel the same, the dr's. don't know enough about osteo. we know more since we have it!!!! It's time to make a change
pamela

By Nita
Posted August 12, 2008 at 12:29 pm
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Momram, my advice to you is to find another doctor. This one you describe does not sound interested or informed. I don't know where you live but I go to a Bone and Mineral Clinic that specializes in people like us and has lots of experience with different medications and the patients who take them. We all talk about our MDs in these chats but we don't mention what KIND of MD and that can make all the difference. I strongly advise you to find another physician with more experience, more knowledge, and more empathy. Find one who specializes in osteoporosis.

By momram
Posted August 12, 2008 at 3:25 pm
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Thank you all for your help. I do believe I should see a different doc. I was being cheap because of the price of gas. The next nearest one is over an hour away. I normally see a family practioner and only go for a routine check up and to renew my prescription. The doc I just went to is a rhuematoligist. He is coming to speak at the Osteo Support group in my town so I was thinking he would be very good. Maybe I should have heard him first.

By Eamenard
Posted August 12, 2008 at 7:22 pm
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Were the scans done on the same machine? From what I have read, DEXA scans can vary by manufacturer and from machine to machine of the same manufacturer. There is no "Gold" standard for these machines. So if you want to compare scores from time to time, it is best to have it done by the same machine. I think the repeatibility using the same machine may be 3% but going from manufacturer A to manufacturer B may be another story. You need to pay attention to these details for comparison purposes.

By nobonesaboutit
Posted August 12, 2008 at 11:11 pm
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When my Dr reccommended Forteo, my ins co made us go thru a prior authorization. They want to know you tried the cheaper meds without success or couldn't tolerate them. If it takes your Dr's office more than a week to get this, call back. I was a Rn in a Dr office and all it takes is for someone in the office to take the 15min on the phone with the ins co to get it-they may have to fax a form in writing but prior auths really are not that big a deal-the big deal is getting someone to take the time to do it!

By JilleWhite
Posted August 13, 2008 at 1:11 pm
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Momram ~ I would definitely recommend that you talk to your dr. about Forteo. I am using Forteo and my bones are at about -3.5. It is EASY to use. The lady who did the class I took about Forteo told me that Fosamax, Actonel and Boniva are designed to stop the bone from losing more bone mass, but in doing so, it also prevents the bone from building very much bone. Forteo is designed to trigger the bones to build! I encourage you to check into it.
Jill

By Blues
Posted August 13, 2008 at 5:47 pm
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When I posted $2300 for 3 months supply of Forteo that is the total cost (what the plan pays and what I pay) I pay $150. for 3 months.

Today I got the results of my dexa scan (after 1 year on Forteo). My spine went from -2.8 to -2.2; not as good in my hips but some improvement -3.2 to -3.0. I am hoping for better results in my hips when I complete the 2 year treatment next July. I took Fosamax for 7 years and though I saw a little improvement in my spine; my hips continued to get worse so my dr. wanted to try Forteo. Must admit I was hesitant and took a couple of months to make up my mind. I was fortunate that she gave me samples for 2 months when I first started.

By Blues
Posted August 13, 2008 at 6:03 pm
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I also wanted to chime in about getting dexa scans on the same machine. I have been getting dexas since 1998 and they have all been at the same place but they did upgrade their equipment about 3 years ago and now the report gives me comparisons from my baseline (1998) through the most recent ones. I was told in 2002 by another dr. that the scans should always been done on the same equipment.

By windblown
Posted August 13, 2008 at 8:00 pm
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Hi Blues: Congrats on the dxa scores, you must be thrilled!!!! Keep up the good work, and here's hoping the next scan will improve both the hip and spine. I bet the Dr. was excited too. Glad you cleared up the copay on Forteo, I almost feel off the chair when I thought you meant you were paying $2300.00 for 3 months. $50.00 a month is a good price.

Three cheers for Blues :0)

By Alli
Posted August 14, 2008 at 6:37 pm
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Just wanted to ask Kathleen a question on lemon juice for alkaline. How much lemon juice water would be ok to drink for it... I am thinking a few glasses a day maybe??

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