neck density decreasing while hip/spine increasing

bnablosser
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My husband was told that he had Osteopenia (T score -1.5)in 2005 after he was injured in Iraq and had to have surgery on his leg. All we were told was for him to take Calcium and exercise. We didnt think much of it really until recently. He can't become an Officer now even though he has been in the preliminary program for 5 months training. Now it is a big deal. He has a higher risk of breaking bones. He recently had his 3rd DEXA scan and I was happy to see he has improved. He is now (-1.1) which is so close to "normal range". He is .1 away. Does anyone know how to figure out the percentage(risk) for .1 from normal?
I am concerned because in the last 3 years he is losing more bone in his neck. The Spine and Hip have improved but the NECK has gotten worse going from -.3 to -.9 in one year(after the surgery) and in the last 2 years it has changed to -1. I believe I am looking at this correctly as far as negative numbers go. My husband is very active, strength training and running. If he was able to increase his bone density in the spine/hips how on earth can he target his neck bone density? Are there neck exercises? Any thoughts????

8 replies

MotherGoose

This is a case of your not understanding the numbers.
You are not alone there!
Are we talking about T-scores here? They are the customary measuring stick.
First, the DEXA T-scores are based on numbers for postmeopausal white women. Using these scores for others is a relative matter -- meaningful if the scores change, for example.
Here is how the T-scores are determined:
-1.0 to -1.0 is normal. -.3 and -.9 are within the normal range.
-1.0 to -2.5 is termed osteopenia.
-2.5 and below is called osteopoenia.
The potential for going lower -- such as -4.0, -5.3, etc is in the diminished density of the bone. A score of 2.5 and below -- along with the incidence of fractures resulting from minimum force is called severe octeoporosis.
If yur husband's T-scores are better than -1.0 ( and if you are reporting -0.3 and -0.9), he has scores within the normal range for PM white women. No need to worry. -1.0 is the highest score for osteopenia. He is not even at that point. Are you sure of where those decimal points come? (Yes, a score of -3.0 would be of concern, but I doubt that he has a score of -9.0).
To better understand, draw a horizontal line midway down a piece of paper. Above this line is above zero and below this line is below zero. Then -- rising above the line make some more lines a few small, equal distance apart, such as 1/4 inch. Do the same below the line going further away from the zero line.
Number these lines above and below the zero line. Above the zero line is + -- for example, +1.1, +1.2,+1.3, etc.Below the zero line, number the lines -1.1, -1.2, -1.3, etc to -2.0 and then -2.1,-2.2, etc, along to -3.0, etc.
It is below the zero line that we are concerned about. The further from the zero line, the more the density differs from the norm.
Bone density is considered within the normal range from 0 to -0.9. This is where you described your husband's range. Between -1.0 and -2.5 is the osteopenic range and -2.5 and below is osteoporosis.
Consult the information on the NOF website for further details about testing an scores, etc.
Lucy Buckley PT aka Mother Goose

SaraMeeks

Thanks, Mother Goose, for your complete explanation. It sounds as though he is recovering well and is within normal range and is doing ok.
Also, without seeing the report, I believe the NECK here would be the neck of the femur--this is an area of great bone turnover and a score of -.3 to -.9 would be well within normal.

bnablosser

his spine and hip scores have increased to -1.1 but his femoral neck score have decreased . They started at
-.03 and are now -1.0. The charts that I see printed on the report say >-1 are normal....-1 to -2.5 osteopenia...
<-2.5 osteoporosis. If the chart from WHO states that up to -1 is normal then why do you consider only up to .9? The chart is deceiving if this is how doctors look at it. thank you for such a quick response!

bnablosser

p.s. He is almost 37 years old. He has shown he can increase the hip/spine scores,I felt he might reach normal range within the next year. I have read we all lose bone every year after 30 or what not. If was able to increase bone mass even when he is " supposed" to be losing it ... I felt it was a huge accomplishment. The fermoral neck score is diminishing though. Since it has reached -1 already. It will be worse in a years time. He has to be within normal range to be able to re enter the officers program. Would exercise help that bone density get stronger? I wondered if he should start some neck exercises as well.

Eamenard

Dear bna

I'm quite surprised to hear that the military is using DEXA scans in the manner you have described. DEXA scan scores have NOT shown to be related to fracturability which is the primary concern.

I would assume that the scans were not done from the same machine. I have read there is no repeatibilty in test scores from machine to machine. That is, if you are tested on machine A and repeated the test on Machine B, the scores are unlikely to match. Even using the same machine and repeating the test, the 0.1 numbers you are concerned about do not necessarily reflect a real change in his bone mass.

As for exercise, some people have very low T scores(-4.5) doing excercises and have suffered no fractures. Is it the strong muscles that prevent the fractures? If one takes the FRAX test, excercise is not a component in determining "risk of fracturabilty". I don't think there are any studes that have shown that excercise builds bone mass. There have been some reports that a "vibrating platform" helps in this process, but with the lack of attention being given to this, I suspect it isn't so.

Then there are the Rx's. But let's not go there.

Was your husband's leg fracture caused by some sort of accident? And with the forces being put on his leg, should one expect it to fracture? This might be the concern of the military folks if they think the leg fracture came about too "easily". People with DEXA scans in the osteopenia range can have "easy" fractures.

This osteoporosis thing is in its very early stages and so little is known and what is known is contradictory in many cases. Again I'm surprised the military doctors would not know this and then again the medical profession has become very specialized and civilian doctors can't keep up. Were the military docs specialist in this field so they would know the limitations? Are there other reasons for their behaviour? Do they need to reduce the field and are using this as a factor?

There are many other areas that one could discuss about the limitations of our knowledge. Read "The Myth of Osteoporosis" for another viewpoint.

Wishing you both well. I don't think you guys can win this one? Perhaps he should try the FRAX test. They (the Military) might recognize that since it is sponsored by WHO. Do a search on this site for FRAX and go to the website mentioned in earlier posts. Worth a try.

bnablosser

No the scans were done on 3 machines.I will look into the FRAX.I think that his broken leg(right above the ankle) could be thought of as easy. BUT if you listen to how it happened and the circumstances I don't believe it was. Unfortunately it wouldn't matter anyway because I have read the surgeons report of the surgery and he labels my husband as having "extemely brittle bones". This is why he got tested. He was -1.5 at that point. The doctors that saw him after that said he was "slightly below normal" and to take calcium and exercise. A year later he got tested at the VA in SF and it was -1.4....again the doctors made no big deal out it...we had no indication that it could prevent him from having a career. Well a year from that he punched a cabinet in anger and broke a bone in his hand. This doctor said in his notes that it is common "boxers break" or something like that. No mention that his hand bones looked bad. With these 2 breaks and the "Osteopenia" I'm sure he was red flagged. No the doctor was not a specialist in the field of work he is trying to pursue. Supposedly the military state doctor looked at it and said "No'.They actual need Officers. His commander approached another major about the issue and he shut him down and said NO because he has osteopenia and at his risk for breaking bones. Something like that. I will definitely look into the book you suggest. Thank you again for your suggestions!

bnablosser

Good News!! After reviewing my husbands latest results he has been approved for that physical and can re-enter the Officer's program. What a relief. I thought I should follow up. Thank you for all your suggestions and all this good information.

nobonesaboutit

Dear bnablosser,
Just wanted to say God bless you and your husband. Know that so many Americans support our military and want them to have good health care. The military and their families deserve it and we as taxpayers really want that to happen. We're so glad there are those like your husband who chose to serve. (My husband was once in the Air Force.)Take care and thank you again.

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