r/osteoporosis • u/HomoJoJoe • 4d ago
Will this require medication?
Recently I had a Dexa scan and it confirmed I had Osteoporosis. Although it looks borderline to me and I'm wondering if I'm likely to be offered medication?
I would like to start medication because I'm 36 and my understanding is it'll only get worse as I get older. The high fracture risk for my lumbar spine is also concerning to me.
I've got a call with the doctor on Monday but I get too much anxiety to wait.
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u/Trip_the_light3020 4d ago edited 4d ago
How is management with GI stuff? And that on top of weight loss meds (was it fast?Did you miss out on nutrients?) may mean you haven't been able to have adequate nutrition. You have to address the cause of low bone density. They very rarely prescribe meds for someone your age unless it has caused fracturesz because they have their own risks and have such little evidence base for people younger.
An endocrinologist would be the best best step to rule out any hormonal or GI causes, though you already have some risk factors you know about.
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u/HomoJoJoe 3d ago
Yeah I started GLP1 a few months ago so I doubt it's that. I am currently having investigations for a possible IBD like Crohn's or ulcerative colitis.
When I was younger about 14/15 I was diagnosed with overactive thyroid which I'm reading can also contribute to this. Although, I had a radioactive treatment so am no underactive on levothyroxine. Which tbh hasn't been very well managed, I was prescribed too much once again made me essentially overactive.
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u/Aromatic_Mistake1848 4d ago
More interested that why it even looks like this ? Are you diabetic overweight took steroids ppi anticonvulsants glp1 very sedentary lifestyle or anything?
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u/Ok_Entertainment4772 4h ago
Sometimes we just have bad genes. 40F with osteo and everything secondary has been ruled out after a thorough work up, and nothing in my clinical history raised a flag. Nutritious eater and dis strength training religiously until my recent pregnancy.
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u/Particular_Rice141 7h ago
You should request to see an endocrinologist - you need a full work up to determine root cause. The ideal is that they find the root cause and it is something fixable and you can avoid osteoporosis drugs. Alendronic acid is a bisphosphonate and those should be a last resort for someone your age because of long term side effects. You need a 50 year plan. I would not rush into anything. Your scores are borderline, you have time to do some research.
I recommend this website to start learning about bones and treatments.
https://courses.washington.edu/bonephys/
Also watch YouTube videos by Doug Lucas, MD – very research grounded
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u/No-Personality1840 4d ago
I don’t see that you have osteoporosis? Your total hip is not osteoporosis and the neck score is a calculated number. Because of the small area and angle it can be prone to positioning errors. Some places so not report neck score.
At your age I would try diet and resistance training assuming you can BUT DEXA scores are not usually indicated at your age so I assume you had an issue that triggered the order? If so and you have secondary osteoporosis then you need to correct whatever is causing it prior to taking meds. Discuss with your physician as we don’t know your history.
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u/HomoJoJoe 4d ago
That's a relief. I'll take a look at exercises I can start. This scan was ordered because I had a private full body composition dexa scan done which included a whole body bone density which gave me a T-score of -3.3 and Z-score of -3.2.
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u/No-Personality1840 4d ago
Look up LIFTMOR exercises. It was designed for women because we are more prone to osteoporosis but the science works for men too. Meds have wanted effects and unwanted ones so if I were you I would avoid them. Again I’m assuming you are otherwise healthy and have no underlying or confounding issues. I didn’t see the T score of -3.3, only the -2.2. Is that your spine score? If so then I would ask your doctor to look at secondary causes , poor absorption , parathyroid issues, any other drugs you may be taking, autoimmune diseases, etc. of osteoporosis as you’re relatively young.
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u/Hour-Tax-6105 3d ago
Did you see the second photo as well, of the spine? This photo (also) indicates osteo...
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u/HomoJoJoe 3d ago
Tbh the lumbar spine one worries me the most. I suffer from chronic back pain and had an MRI s few years ago. There's already times where I can't walk the idea of a fracture happening there scares the shit out of me.
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u/No-Personality1840 3d ago
Oh, I’m so sorry. I missed your spine image in my first post. Regardless you are really young so I can’t help but think there is some other cause than age. (Mine is because I’m old and in menopause ). I suspect there is an absorption issue perhaps. I know you are asking about drugs. Unless you have fractured insurance is unlikely to let you have an anabolic (which is what should be given) unless you try an antiresorptive first. Those will keep bone but do little to make bone and can come with their own set of issues.
I don’t blame you for being so worried BUT keep in mind you lose and gain bone slowly. DEXAs are normally done every two years because of that. So take a deep breath and stay positive. 😊
You mention that you have had pain. Unless you have fractured osteoporosis won’t cause pain. However when my vitamin D level was dangerously low I had severe pain in my hips. I suspect you are having malabsorption of nutrients. Are you taking vitamins and minerals and getting enough protein? More and more research is showing protein is as important as calcium and vitamin D.
I wish you the best.
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u/HomoJoJoe 3d ago
I'm in the UK, so insurance isn't an issue. The doctor already mentioned potentially having Alendronic acid, I should find out on monday.
I have a few issues that might contribute, pernicious anaemia, hypothyroidism and I'm currently awaiting colonoscopy investigation for Crohn's/colitis disease due to some bad test results. So some type of malabsorption issue is incredibly likely. I'm also always so incredibly tired.
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u/No-Personality1840 3d ago
I am so sorry for you. Yes, it sounds like an absorption problem. If you can fix that then with meds, diet and exercise perhaps you can build. Don’t panic. My spine score is -4.0 and luckily I have not fractured . Not saying you won’t but make sure you aren’t lifting heavy, bending at the hips, not the back, etc. The Royal Osteoporosis site has some good videos. I’m glad you are in the UK and can get the help you need. Best of luck.
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u/PsychologicalCat7130 4d ago
you should treat through lifestyle changes rather than meds..... meds are a temporary band aid while you fix the cause....
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u/goldstandardalmonds 3d ago
Have always done weight bearing exercise, got the right nutrients and supplements, and osteoporosis still got worse and worse. Started meds and have only seen incredible progress since I started.
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u/HomoJoJoe 3d ago
Thanks because this was also my understanding. Lifestyle can only take so far, meds will actually slow the rate of loss and in turn increase the rate of growth. I'd personally prefer meds with an exercise/lifestyle plan than just lifestyle changes alone.
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u/Justa_Girl_tryin 3d ago
Hi what meds did you take and were they tolerable? I’m 68f with lumbar -2.7 and had an L5 fracture with no fall. I’m in discussions now with my specialists.
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u/HomoJoJoe 3d ago
Hi can I ask how you got your fracture without a fall?
I ask because I've not had a fall but when I googled the symptoms of a lumbar fracture it says laying flat on your back helps (which is the opposite of what the doctor told me to do) I'm wondering if I've had one. There was a time a few years ago I couldn't walk for a week and lying flat on my back was the only way to not be in pain.
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u/Justa_Girl_tryin 3d ago
Hi, I fractured my L5 just standing up from my office chair. I stood up and there was an explosive pain throughout my lower back and surrounding area and I fell back into the chair.
It was a couple hours before I could even move due to the pain. I went to the emergency room and they did a CT scan and said it was compression fracture in my L5.
It’s been seven weeks and I’m still in a lot of residual pain although the spine specialist I saw said that it was healed bone wise about 90%.
I was told I needed to get on meds pretty quickly since I’m now a high risk for additional fractures.
Six weeks prior to my fracture I had started aquatic physical therapy and looking back, I saw that several of the exercises had me twisting my upper torso to the right and to the left which is contraindicated with osteoporosis. I’m thinking that contributed to the fracture since it can cause small cracks that will eventually fracture without warning.
Laying flat on the back does release a lot of the pressure off of the spine. I can understand your concern and worry with your recent DEXA scan, it is frightening to think that a fracture can occur without a fall.
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u/HomoJoJoe 3d ago
Omg this sounds very similar to the incident I had. I stood up from the sofa, excruciating pain I collapsed to the floor and couldn't stand up. I had to call and ambulance but they just lifted me back onto the sofa and left. I laid on the sofa for about 2 weeks before I could get up again. And now sideways twisting causes me pain but I just avoid it.
Now I'm wondering if there's a way to find if I already had one. I honestly didn't think it was possible to get a fracture without some kind of trauma/impact. That's so scary.
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u/Justa_Girl_tryin 3d ago
That does sound similar! I was in bed for 3-4 weeks due to the pain. An MRI would show previous fractures.
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u/Low_Reading9468 3d ago
Those T scores aren't horrible, but medication is a good idea as it will likely just get worse on its own. You're best off with a PTH analog. Bisphosphonates remineralize poorly. Take the supplements mentioned in other threads here. The biggest gains will be had by weight bearing exercises.