No bones about it, this is a very sexy topic.

[missy]

OK, it isn't a sexy topic but I wanted to get your attention.
It is an important topic and if I can help even just one person it is worth it.

This is a PSA about getting a bone density test.

If you or your loved ones are female, post menopausal and/or thin/small boned- please consider getting a DXA and TBS.
Even if you don't fall into one of the above categories but have other risk factors please consider getting this test.

DEXA/DXA stands for dual-energy X-ray absorptiometry.
It is a very low level of radiation (about 1/10 of what you get on an airplane flight) or 1/5 of a chest X-ray.

TBS stands for Trabecular Bone Score which is a measure of one's bone quality.
It is a software program attached to the DXA.


This is rarely talked about (with your primary care doctors and/or gynecologists) and that is unfortunate because there is so much one can do before one's bones reach the osteoporotic stage.

The DXA (and TBS) is a painless test. Knowledge is power.
If you get diagnosed early enough there is so much you can do to reverse it and prevent osteoporosis.

Bone Density Test, Osteoporosis Screening & T-score Interpretation

Learn about osteoporosis bone density testing from the National Osteoporosis Foundation.

www.nof.org

It can happen to men as well but it is much more common in women and it is a huge public health concern.

I encourage both men and women to get tested at a reasonable age depending on one's risk factors to get a baseline and see where you are and take appropriate measures to prevent bone loss.



And one other very important cause is if one has an eating disorder.
So if you or a loved one suffers with an eating disorder please take note and get tested.
It isn't too late to do something about it and help improve your bone health.

An overview and management of osteoporosis

That's all I wanted to share. If anyone has questions I am more than happy to answer them if I can. I have done a lot of reading/research in this area and know more than I ever thought I would about this topic.

Wishing you all good health so you can enjoy your loved ones and your beautiful bling for a very long time.

 

[dk168]

I know about it, however, I have not had a test yet, and shall make enquiries when I have my next 6-monthly health check in September 2021.

DK

 

[maryjane04]

I have had DEXA scans but not to monitor bone density. It's used quite frequently in the personal training space to monitor body fat/lean mass percentages. It was quite informative when I was going through a weight loss phase and preserving muscle mass was really important to me.

 

[missy]

I have had DEXA scans but not to monitor bone density. It's used quite frequently in the personal training space to monitor body fat/lean mass percentages. It was quite informative when I was going through a weight loss phase and preserving muscle mass was really important to me.

Oh yes. When one loses weight one often loses bone density along with it. I am glad you are being proactive.

I know about it, however, I have not had a test yet, and shall make enquiries when I have my next 6-monthly health check in September 2021.

DK

I am glad to hear this @dk168 and good luck.

 

[maryjane04]

One of the pros of weightlifting/resistance training! I think they say it's after 40 years that your muscle mass declines. But yes strong muscles = strong bones!

 

[missy]

One of the pros of weightlifting/resistance training! I think they say it's after 40 years that your muscle mass declines. But yes strong muscles = strong bones!

Yes 100% agree. It’s one of the best things we can do for ourselves!

 

[TooPatient]

I have heard of but never had the test done. My grandmother has ostiopedia (if I am remembering that correctly) which is similar to osteopetrosis (again, if I remember correctly).

How do they do the test? Is it just an x-ray like scan? My assumption when it was mentioned to me years ago was that it is a very painful invasive test and I would rather not ever have it. No reason why, just my assumptions at a young age and I have not yet reached an age where a Dr would mention one.

Very curious to hear more, especially as it relates to weight loss. (Sounds like I might want to go back to the specialist for monitoring even though I am able to lose weight on my own with the information and help she gave me!)

 

[missy]

I have heard of but never had the test done. My grandmother has ostiopedia (if I am remembering that correctly) which is similar to osteopetrosis (again, if I remember correctly).

How do they do the test? Is it just an x-ray like scan? My assumption when it was mentioned to me years ago was that it is a very painful invasive test and I would rather not ever have it. No reason why, just my assumptions at a young age and I have not yet reached an age where a Dr would mention one.

Very curious to hear more, especially as it relates to weight loss. (Sounds like I might want to go back to the specialist for monitoring even though I am able to lose weight on my own with the information and help she gave me!)

It is a very simple and totally painless test. You lay there and the machine scans you. The tech or doctor positions you in order to get accurate findings. It is quick (5 minutes) and easy.

I wish I knew then what I know now and that is the reason I started this thread. Osteoporosis is truly a preventable disease if you take the appropriate measures and are monitored via DXA.


It isn't just for older individuals. It depends on many factors. Certain meds (steroids, breast cancer meds, prostate cancer meds. Heartburn meds, depo-provera, Thryoid hormone replacement, Anti seizure meds, blood pressure meds etc) can make you more likely to get OP and also
certain diseases (Celiac disease, IBD, Kidney Dss, Liver Dss, Cancer, Lupus, MM, RA etc) can make one more likely to get OP and at an earlier age.

Other issues that can put you at greater risk. If you go into early menopause or if you stop getting your period for any length of time etc these all are risk factors for OP.

Eating disorders are a big cause of OP. I would say if I had to guess that 100% of anorexics who remain anorexic get OP at an early age.

Hope that helps @TooPatient and if you can get a DXA it is worth it for peace of mind and then you have a baseline from which you can compare future DXAs. If yours is good you can get one every five years until you reach age 50 and then if all is still good you can get one every 2 years. It really depends on one's risk factors and one's health history and medications one takes.

And I cannot emphasize this enough. Everyone should be lifting weights and working out with weight bearing activity on a regular basis.

 

[Tartansparkles]

We have body fat scales that also measure bone density - is that just a gimmic or does anyone know if the results are 'good enough'? I also signed up to Les Mils barre classes (on demand/online), they include quite a lot of 'ballet-type' jumping which is a lot harder than it looks (and in my case, a lot less graceful!)

 

[Polished]

I had one of these tests and I'm due for another. I assumed my bones were good as I do a lot of walking and running. Turned out this meant that while my hip bones were good through doing this exercise my back bone was near to having OP. I needed a wider variety of exercise and weights to address this issue.

 

[Queenie60]

I have had several scans over past 20 years since breast cancer. My last scan showed pre-austeopena. Since then, I have taken more calcium, incorporated weight training and much more walking. I will have another scan before year end to see if there's improvement.

 

[maryjane04]

We have body fat scales that also measure bone density - is that just a gimmic or does anyone know if the results are 'good enough'? I also signed up to Les Mils barre classes (on demand/online), they include quite a lot of 'ballet-type' jumping which is a lot harder than it looks (and in my case, a lot less graceful!)

Body fat scales have a higher degree of error as it cannot differentiate water from muscles and fat. But it could be used as a tracking/measuring tool for progress.

The DEXA is an imaging machine that factors in everything but even with that - dehydration could cause the results to be a little bit off.

I have heard of but never had the test done. My grandmother has ostiopedia (if I am remembering that correctly) which is similar to osteopetrosis (again, if I remember correctly).

How do they do the test? Is it just an x-ray like scan? My assumption when it was mentioned to me years ago was that it is a very painful invasive test and I would rather not ever have it. No reason why, just my assumptions at a young age and I have not yet reached an age where a Dr would mention one.

Very curious to hear more, especially as it relates to weight loss. (Sounds like I might want to go back to the specialist for monitoring even though I am able to lose weight on my own with the information and help she gave me!)

I can show you what a DEXA scan report is like - mind you this is not for bone density - I was using it for weight loss. I haven't done another scan for a while as I am not on a diet phase.

P.S. It's like an MRI - you lay down flat and this machine just hovers over you taking measurements

 

[MamaBee]

Thanks for reminding me @missy.
I had it done many years ago. I have osteopenia..I may have osteoporosis at this point because it’s been about eight or nine years. I need to get it done.

 

[Jambalaya]

I'll ask my doc about it. I'm not post-menopausal quite yet, but I'm going through it and recently my hip joints have started aching.

 

[Mreader]

@missy thank you and I will ask my doc! I know everyone’s plan is different but would insurance cover this type of test or would it depend on age or risk?

 

[bright&shiny]

Lol - such click bait, but worthy. I’ve been putting my bone density test off, but I will no longer. I’m going to schedule it this week. I have a bunch of health issues, but asthma and resulting frequent doses of prednisone make I even more important. Thank you for your PSA!

 

[missy]

Thanks for reminding me @missy.
I had it done many years ago. I have osteopenia..I may have osteoporosis at this point because it’s been about eight or nine years. I need to get it done.

Yes, please do Joanne, I was going to ask you about it in NIRDI as I remembered you promised me you would. I didn't want to be a pain but I would rather be a pain to you now than you be in literal pain later. XOXO.

@missy thank you and I will ask my doc! I know everyone’s plan is different but would insurance cover this type of test or would it depend on age or risk?

Yes, in the great majority of cases your physician can code to get it covered. If you go to someone who is well versed in bone health it shouldn't be an issue. I had no risk factors (besides being caucasian and thin) and had my first bone density in my 30s. I was normal. And it was completely covered. But then I waited too long to get my next one because I didn't realize the importance.

I'll ask my doc about it. I'm not post-menopausal quite yet, but I'm going through it and recently my hip joints have started aching.

I think you are close enough and at the very least you can get a baseline to compare to when you are post menopausal. It will provide a valuable comparison.

I have had several scans over past 20 years since breast cancer. My last scan showed pre-austeopena. Since then, I have taken more calcium, incorporated weight training and much more walking. I will have another scan before year end to see if there's improvement.

Good luck @Queenie60, having osteopenia is reversible much more so than osteoporosis.

I had one of these tests and I'm due for another. I assumed my bones were good as I do a lot of walking and running. Turned out this meant that while my hip bones were good through doing this exercise my back bone was near to having OP. I needed a wider variety of exercise and weights to address this issue.

Yes, as we discussed it is critical to work the whole body with increasing weights. The key is to keep making it more challenging so we can strengthen muscle and bone. You are doing great and I have no doubt you will keep your bones strong and healthy. Knowing where you are and what you need to do is half the battle.

We have body fat scales that also measure bone density - is that just a gimmic or does anyone know if the results are 'good enough'? I also signed up to Les Mils barre classes (on demand/online), they include quite a lot of 'ballet-type' jumping which is a lot harder than it looks (and in my case, a lot less graceful!)

From what I understand these are very inaccurate for bone density measurements. Nothing beats the DXA. It is the gold standard of bone health evaluation. And so is the TBS as that evaluates bone quality which is an important part of the picture. Bone density only tells us so much and we need to see the bone quality too in order to evaluate fracture risk and safe treatments.

Lol - such click bait, but worthy. I’ve been putting my bone density test off, but I will no longer. I’m going to schedule it this week. I have a bunch of health issues, but asthma and resulting frequent doses of prednisone make I even more important. Thank you for your PSA!

My pleasure! I love you guys and just want everyone to be as healthy and well and good as possible.


As I wrote before there is much we can do to take our bone health into our own hands. In order to know where we are starting from, and to evaluate our risks, and how to proceed, and what exercises are safe for us, etc. a DXA is a good place to start.

 

[missy]

Here's a sample DXA report of the spine. You can see T scores (comparing you to a healthy 30 year old's bone) and Z scores (comparing your bone density to the average bone density of people your own age and gender).

Understanding Bone Density Results - Your T-score & Z-score Explained

Your bone density report can include two tests, the T-score and the Z-score. The T-score on your bone density report shows how much your bone mass differs from the bone mass of an average healthy 30 year old adult.

americanbonehealth.org

What Does a DXA Scan Diagnose?

A DXA scan is an imaging test providers use to screen you for osteoporosis. Learn how it works and when you’ll need one.

my.clevelandclinic.org

 

[seaurchin]

Thank you for this thread, Missy. I'll definitely have to look into this.

 

[RunningwithScissors]

Thank you for posting this. I know that I'm in a high risk group being very thin, caucasian, menopausal, and having a family history of osteoporosis. My grandmother died from osteoporosis (specifically a collapsed spine.)

I had never heard of this test, but I will request it when I next see my gyn.

Seriously, thank you!

 

[missy]

Thank you everyone who commented. I posted this in the hopes it would help at least one person and hopefully many more. For whatever reason our doctors don't usually mention this test till it is too late. This needs to change. I am on a mission to spread the word to help prevent debilitating fractures. Fractures that can ruin our quality of lives. There is much that can be done to prevent reaching that point.

@RunningwithScissors same. I am sorry about your grandmother.
We also have a very strong family history (mom, dad, grandmother) of OP plus being Caucasian, thin, early menopause, etc. Please let me know how you are doing and I have lots of tips if you need them once you get the DXA and your results. Good luck!

@seaurchin thank you and good luck. I cannot stress enough how easy the test actually is. Definitely worth doing. Knowledge is power.

 

[RunningwithScissors]

@missy are you on hormone replacement therapy? I know you are a doctor and know more about these things than I ever will, but my obgyn recommended it for me, saying that it helps with OS and he highly recommends it for women with our risk factors. I'm doing the lowest dose possible and so far it has really helped me with all the other unpleasant things that come with menopause (hot flashes, fatigue, etc.) What is your opinion on HRT in general? I know there are different opinions on it, including whether it slightly increases breast cancer risks.

 

[missy]

@missy are you on hormone replacement therapy? I know you are a doctor and know more about these things than I ever will, but my obgyn recommended it for me, saying that it helps with OS and he highly recommends it for women with our risk factors. I'm doing the lowest dose possible and so far it has really helped me with all the other unpleasant things that come with menopause (hot flashes, fatigue, etc.) What is your opinion on HRT in general? I know there are different opinions on it, including whether it slightly increases breast cancer risks.

Hi @RunningwithScissors, I am glad you are reaping benefits from hormone replacement.

I am taking BHRT and I am very pro hormone replacement. I just started this past December and I have already seen bone benefits.

If you are interested I highly recommend the book Estrogen Matters. A lot of physicians are still unfortunately scared to prescribe HRT based on a faulty study- The World Health Initiative Study. When done properly it is safe and effective. And can be continued for the rest of our lives for most of us.

HRT has a role in the prevention of osteoporosis but long term use is required to continue its benefits.

HRT helps brain and heart health as well as bone health. It is a critical component of aging healthfully.

The dose and duration of HRT use should be made on an individual basis after discussing the risks and benefits. No arbitrary limit should be set on duration of use.

Recent studies by the National Institutes of Health have confirmed that bioidentical hormones are safer than synthetic hormones and are less likely to cause serious illnesses, like breast cancer.

To reap bone health benefit your blood levels of estradiol must be at least 50-60 or higher. Some studies state 75 and some state 50. My best educated guess is 60 or higher.

Testosterone also plays an important role in women's health including bone health as does Progesterone.

Hope that is helpful and I am more than happy to answer any questions. I am not an expert but I do know a lot more now (after exhaustive research of medical journal articles and real life experiences) than I did before I started this journey.

 

[RunningwithScissors]

Hi @RunningwithScissors, I am glad you are reaping benefits from hormone replacement.

I am taking BHRT and I am very pro hormone replacement. I just started this past December and I have already seen bone benefits.

If you are interested I highly recommend the book Estrogen Matters. A lot of physicians are still unfortunately scared to prescribe HRT based on a faulty study- The World Health Initiative Study. When done properly it is safe and effective. And can be continued for the rest of our lives for most of us.

HRT has a role in the prevention of osteoporosis but long term use is required to continue its benefits.

HRT helps brain and heart health as well as bone health. It is a critical component of aging healthfully.

The dose and duration of HRT use should be made on an individual basis after discussing the risks and benefits. No arbitrary limit should be set on duration of use.

Recent studies by the National Institutes of Health have confirmed that bioidentical hormones are safer than synthetic hormones and are less likely to cause serious illnesses, like breast cancer.

To reap bone health benefit your blood levels of estradiol must be at least 50-60 or higher. Some studies state 75 and some state 50. My best educated guess is 60 or higher.

Testosterone also plays an important role in women's health including bone health as does Progesterone.

Hope that is helpful and I am more than happy to answer any questions. I am not an expert but I do know a lot more now (after exhaustive research of medical journal articles and real life experiences) than I did before I started this journey.

Thank you so much for taking the time to tell me (and others) what you have found in your research. I will order that book and dive into it.

Even before reading your post, I guessed that I would have to be on HRT for life because the women in my family suffer from extremely bad and frequent hot flashes for the entire rest of their lives (we never "come out the other side" like other women do.) I just couldn't take the suffering. I knew that even if there was a chance that HRT shortened my life, I would still do it because I literally couldn't live with the severity of the flashes (couldn't sleep, couldn't eat a full meal, couldn't get any work done, etc.) So its great to hear that research is showing positive long term benefits of HRT.

Here is a really stupid question -- how do I tell if the hormones I am currently on are bio identical or synthetic? I wear an estrogen patch, take a progesterone pill at night, and have a testosterone pellet injection every 3-4 months. I was never told about differences between bio-identical or synthetic by my obgyn, so I never asked.

 

[missy]

Thank you so much for taking the time to tell me (and others) what you have found in your research. I will order that book and dive into it.

Even before reading your post, I guessed that I would have to be on HRT for life because the women in my family suffer from extremely bad and frequent hot flashes for the entire rest of their lives (we never "come out the other side" like other women do.) I just couldn't take the suffering. I knew that even if there was a chance that HRT shortened my life, I would still do it because I literally couldn't live with the severity of the flashes (couldn't sleep, couldn't eat a full meal, couldn't get any work done, etc.) So its great to hear that research is showing positive long term benefits of HRT.

Here is a really stupid question -- how do I tell if the hormones I am currently on are bio identical or synthetic? I wear an estrogen patch, take a progesterone pill at night, and have a testosterone pellet injection every 3-4 months. I was never told about differences between bio-identical or synthetic by my obgyn, so I never asked.

Not a stupid question at all. It's a very important distinction to make and it's a great question.

It's bioidentical if the ingredients listed are estradiol or testosterone or prometrium or progesterone. Instead of having a prefix before it such as Ethinylestradiol which is synthetic and you can tell by the name. For example, if the ingredient listed is estradiol it is bioidentical.

Patches are mainly bioidentical so you are OK there. If your Progesterone pill states Prometrium you are OK as that is bioidentical. If it states progestin it is not bioidentical and it is synthetic. And AFAIK testosterone pellets are bio-identical but ask your doctor because I am not well versed with pellets. Personally I am doing Estradiol Cypionate and Testosterone Cypionate injections twice weekly and Progesterone pills which are bioidentical.

Examples of Bioidentical testosterones are Testosterone Cypionate or Testosterone Propionate.
Other examples of bioidentical estradiol is Estradiol Cypionate. No prefix before the word Testosterone or Estradiol.

Synthetic does not match our molecular structure, Bioidenical (which is synthezized but not considered synthetic) does. Premarin is synthetic, estradiol is synthezized. It can be confusing but synthetic vs bioidentical. Both made in the lab but only one matches are molecular structure.

As another example of where bioidentical is better than synthetic is the case of progesterone. Bio-identical P proves to be protective of the breasts in many people. Whereas synthetic hormones do the opposite.

Summing up. Some forms of hormone replacement therapy prevent serious diseases such as breast cancer, heart disease, osteoporosis and neurological degeneration, while other forms actually increase the risk of these diseases. The devil is in the details and this is the case where bioidentical is superior to synthetic hormones almost all the time. Not to be confused with the fact that bioidentical are synthesized but not synthetic. They are all made in a lab and man made but bioidentical are made with their molecular structure identical to those in the body, thus the term “bio-identical”.

It can be confusing and I hope my explanation was clear. If not I am happy to expand upon it. Sometimes it is harder to write it down vs just having a conversation about it and summing it up in a succinct post is challenging for this complex topic. I have just touched upon it and am happy to talk more about it if you would like.

 

[missy]

More examples.

Old hormone replacement was synthetic, nothing about it matched your molecular structure and had names like ethylestradiol.

Today we have synthesized hormones that match your molecular structure. For example. Just estradiol, no other letters.

Notice in the graph the differences.



Estradiol is estradiol =synthesized.
Ethylestradiol =synthetic
Progesterone/prometrium =synthesized.
Medroxyprogesterone =synthetic
Testosterone is testosterone =synthesized.
Methyltestostorone=synthetic.


Technically, yes it's all synthetic as a manufactured product but for the purpose of the explanation this is how I am referring to non bio-identical vs bio-identical. Synthetic vs Synthesized. Hope that makes sense.

 

[RunningwithScissors]

Thank you, thank you, thank you. This is an extremely helpful and clear explanation. I know it took time for you to type this out and I am very grateful that you did it for me and for all of us.

May I ask one more question? (I'm hoping this will be helpful for others too.)

You said your best, educated guess is that the level of estrogen in our blood should be around 60 (for a post-menopausal woman who is otherwise in good health). What about testosterone? What level do studies suggest is a target to maintain longterm bone, muscle, cardio, and brain health?

 

[missy]

Thank you, thank you, thank you. This is an extremely helpful and clear explanation. I know it took time for you to type this out and I am very grateful that you did it for me and for all of us.

May I ask one more question? (I'm hoping this will be helpful for others too.)

You said your best, educated guess is that the level of estrogen in our blood should be around 60 (for a post-menopausal woman who is otherwise in good health). What about testosterone? What level do studies suggest is a target to maintain longterm bone, muscle, cardio, and brain health?

Another great question.

So it's not surprising your doctor doesn't have the levels since they received very little training in medical school on hormones and menopause. One hour training to be exact. And when it comes to levels there are ranges but often the ranges don't apply to us as individuals and we have to find our sweet spot regarding ranges.

Having said that, the top of the lab range for the standard Free Direct T test is 4-5 for Labcorp and Quest. Running significantly higher than that risks many side effects such as hair loss, dangerous elevation of hematocrit which can lead to blood clots, acne, etc. So you don't want your free T too much over the high range of "normal" of the lab range.

We are all different and there really aren't any absolute numbers one should aim for unlike Estradiol where we know you want at least 50 and up to 150 for heart, brain and bone health and libido too. It's not just T that gives is libido it's estradiol as well. I said you want at least 60 E for bone health but up to 150 provides many benefits if you do well with tolerating it.

Back to Testosterone.
Your T level depends on a number of things. We are mainly looking at free Testosterone vs total.
And SHBG comes into play making it all very complicated and most doctors don't know what to do with SHBG. Sex Hormone Binding Globulin.

Total Testosterone is whatever is circulating which includes free and bound.

The higher SHBG is the more will be bound as a percent of total. When it’s bound it can’t act on receptors and isn’t metabolized rapidly.

When it’s free it can act on receptors and is cleared rapidly. So when you have high SHBG your total is going to be higher if you’re not hypothyroid. If your SHBG is low your total will be lower if you’re not hypo.

Basically Total testosterone is what's in storage and the free testosterone is what is able to work right now.

Free Testosterone is what is most important. Too much free causes side effects just like having it too low. Different side effects but more isnt always better.

So I wrote a lot but it basically comes down to how you are doing with where your levels are now and adjusting as necessary being careful not to get too high (or too low).

Hope that helps.

 

[RunningwithScissors]

Thank you @missy, you are awesome!

 

[Mreader]

Taking the opportunity to bump this thread and thank @missy for bringing up this important topic! I got mine done today and I never would have thought to ask my gyn about this had it not been for this post.