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At what stage / number should we worry about breaking something?
Thanks
Katia
At what stage / number should we worry about breaking something?
Thanks
Katia
Katia I understand once your scores hit -3 statistics show one can fracture more easily .. having said that some people levels are -3.5 but have never fractured others fracture at 2.5. It depends on each one's flexiblilty and how strong your bones are but the medical statistics say after -3 you are in the dangerous zone or I should say one is at high risk.
Oh, dear!
Please, do not hang your hat on the numbers!
BMD testing is a valuable tool for determining the density of the bone, but it is not the only tool. There are MORE fractures in those with osteopenia than with osteoporosis. That is because there are more people with osteopoenia (generally younger). Bone loss indicates a problem, but not the whole picture.
Please read about FRAX, the new tool developed by global experts that can predict over a 10-year span your risk of fracture depending on many elements -- age, sex, ethnic background and family history, height, weight, balance, strength, etc. It is designed to assist primary health providers determine with thier patients what course may be best for each person's unique situation. A woman in her 50's may break her wrist and "only"have osteopenia (by the numbers). She still has a a fracture due to bone loss. Not so serious for her as a hip fracture might be in 20 years, BUT, why try to not head off the hip fracture NOW, while she can?
Lucy Bucklry PT aka Mother Goose
Katia,
That is an excellent question but there is no clear-cut response. I agree with Alli's answer that different people may fracture with different T-scores. Risk of fracture can also vary with age.
The T-score is only a measure of bone mineral density (BMD). It does not measure tensile strength. Osteoporotic bones are sometimes referred to as brittle because they have hardness and rigidity but little tensile strength, thus breaking readily. I have read research reports in which cadaver bones were tested for strength, but we currently don't have a strength test for the bones of live subjects.
Getting back to the T-score...A score of 0 to 0.9 is normal bone mass, -1.0 means bone mass is 10% below average, -1.5 is 15% below average, -2.0 is 20% below average, -2.5 or lower is 25% or more below average and is considered osteoporosis. All the scores are relative to the average bone mass of healthy, young premenopausal women with a T-score of 0.0.
I hope this helps.
Katia, I was diagnosed with osteoporosis in -3 range hips and spine almost 11 yrs ago. I'm now 61, fracture free and very physically active. I intend to remain fracture free. I don't what if or anticipate having a fracture. According to the stats, if there is a possibility that I will fracture, there is also a possiblity that I will not fracture. I am not defined by having osteoporois. I happen to have bone loss, but osteoporosis does not have me (if you understand what I mean). While fracture risk may be of help to health professionals, personally I am not interested in checking off test statements that determine my fracture risk. The fact is I have osteoporosis. I'm more interested in doing what I can right now that will keep me fracture free. I don't want to project 10 yrs from now. I do realize that as I age, the possibility may be greater, but I rest on the shoulders of the community members that are in their 70's that are productive and physically able .... and I hope eventually to read posts from community members that are age 80 that have bone loss and remain fracture free. Try to stay in the moment. Take the advice and use what will work best for your life and try not to worry. There is only so much control that we have. Sometimes the unexpected happens in life and we have to do the best that we can at that time. I certainly wouldn't sit and wait for a fracture. Meanwhile, become informed about osteoporosis. Utilize the community for support and encouragement. This is the place to vent, share concerns and fears. Be sure if you have concerns, there is another community that has the same concerns or has been through the same concerns. Sandi
Dear Katia:
The responses above cover the ambiguity of the Dexa numbers very well leaving you with a large unknown void.
I assume you got a number that is of concern to you. The next step is to get further tests to rule out any secondary causes and get those taken care of. Make sure you get a knowledable doctor to work thru these items. Don't just jump to the Fosamaxes as many docs do. Read as much as you can because this area is a large unexplored territory and nothing adds up correctly as you will see. Read the "The Myth of Osteoporsis" and get one prespective. Osteoporsis is a slow so you have time to make your own decision as to what course to take. Read as much as you can about the drugs and their downside. They come with a price you might not want to pay to offset the odds of fracture. One can only take their best guess as to the course of action. Good luck and enjoy the journey.
WOW... here I thought I had a simple question and It would be so silly no one would even want to answer it.
Thank you all for your contributions and advice. I really thought this would be quite simple but apparently its more of a science and i have a lot to learn.
I would love your opinions on the following.. kind of a "what would you do" in my situation scenario?
As Eamenard asked I do have a number that I am concerned about but I am not newly dxed. I was dxed in 2001 at 36 and scans were done again in 2005, 2006 and early 2008. Each time the scan gets worse and now at 42 as of today it's -3.4. Another scan will be done on Monday.
I have been in menopause since 1993 (15 years) , had breast cancer at 36 with chemo, battled anorexia and bulimia from age 7 to 30, and my mom and her sisters are hunched over little older ladies in their 80's with humps on their backs. I broke my wrist in 2007 wiping up a spill on the kitchen floor with a baby wipe and I have battled a balance problem since 2001 that has progressed this year and is now so bad I am walking with a cane.
My only saving grace at this stage is i'm a chubby lil thing so when i fall i have something to fall on.
I have tried all the oral drugs years ago and my stomach didn't tolerate it so I asserted myself and said no to meds and with each test my numbers dropped. My oncologist the last few years has strongly suggested Zometa and i strongly declined.
Now the rhuematologist is strongly suggesting Reclast as I have been falling into walls etc and he said one bad fall and I break my back.
Along with all this is a failure to keep vitamin D in my body and no one can find out why..
So I have to think and weigh.. side effects or a broken bone? Not a decision I want to make...
OK.. so thats my life now the question I'm asking is "what would you do"
Thanks in advance
Katia
Ok one last thing to toss in the loop before you give me your opinion. I took Mother Gooses advice and found the FRAX website.
Even with all the "risks" in my last email, FRAX tells me I am only at a 10% chance of a fracture in the next 10 years.
So... is it then worth all the side effects from Reclast for a percentage so small?
WOW big decison.. what would you do?
thanks
Katia
Katia:
With your health history -- menopause so young --cancer and treatment -- eating disorders -- small wonder that you have such bone loss. Yes, your "chubbiness" is some protection when you land, BUT --- why are you falling so much at your age? (I do not remember if "frequent falls" as a question on the FRAX). You have already had an osteoporotic fracture -- the wrist fx is considered such. Having a "first fracture" adds to your risk of future fracture.
You should not rule out Reclast. There are preliminary instructions to minmimize the post-infusion side effects that a few people have had. Discuss this further with your doctor(s). Also discuss why you are falling so often. That should be addressed regardless of how you proceed with medication.
Lucy Buckley PT aka Mother Goose
Dear Katia
As Mother Goose pointed out, you have already gone thru the "best" osteoporosis test-fracture for little cause. Forget the DEXA and Frax, you are already diagnosed and the numbers are irrelevant.
I'm not sure what your docs are doing, but I would think you need to get to reason as to why your Vit D isn't working, This secondary effect needs to be fixed. What about parathyroid, urine, blood,etc? Making bone is a chemical process and everything needs to be in balance for the process to work in your body-potassium, magnesium, D, calcium, etc. You need to build back your bone. The only drug on the market building bone that I am aware of is Forteo.
So your first step is to find the RIGHT doctors to get your chemistry in order. The goal after that would be to go on Forteo to build back the bone. During this "build back" there are tests to prove your body is building bone. If these tests indicate you are building bone, then the chemistry is in order. If not, you have got to go back and determine what part of the chemistry isn't in balance and get that fixed -if possible. Build as much bone as you can with Forteo so keep getting tested during this interval to be sure your chemistry is right.
I hope you will keep us posted as you go along. Start a journal on this site so we can see how you are doing. Let us know when you post something if you do start a journal.
Best Wishes
To the question "What would you do?" I think I would find out why I am falling so much. Whatever else one does for this condition--medication, diet, thinking positive etc.--if you fall, you increase your risk of fracture no matter what your T score is.
Physical Therapists test for fall risk with all kinds of different tests that have stood the test of time over the years. Although you already know you have a fall risk, you don't know why. If you do go to a P.T. make sure it is one who is knowledgeable about osteoporosis because there are some tests that would also put you at risk for fracture.
Balance is a complicated function of the body and is related to strength as well as to function of the nervous system, vestibular system, sensory system,etc. There could be something else besides osteoporosis going on that would increase your fall risk.
This is one thing I'd get checked.
Katia,
I rarely write, but one thing I am passionate about is balance problems. Please have a vision exam. A problem in one eye can mess up your brain and inner ear - especially if you wear glasses intermittently. Also, absolutely avoid progressive lenses. They have come a long way, but they still leave a focus correction gap from about your knees down thus leaving a problem with exactly where you are putting your feet in relation to the ground, steps, etc. Of course, if you are looking straight down at your feet there is very little awareness visually of anything else around you - people, walls, and in my case the low hanging tree branch I hit with my face while mowing my yard. Rapid movement of your head upwards or to the sides can give you instant, albeit brief, vertigo. I was fortunate to find at a regular exam that I was legally blind in my right eye. Surgery corrected it and I haven't "tipped or tilted since". Vision is an easy check and inexpensive compared to the cost of medication or a fracture. (Me - wrist, ankle, elbow, knee and no insurance)
Please check your eyes and be careful about the corrective lenses you might need.
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