Benefits of dexa scan??? - Page 2

jck77 · 08-03-2012, 03:33 PM

Quote:

Originally Posted by LaMemChose

After having x-rays of a swollen, painful, purple foot and ankle, I was told I have very brittle bones. Knowing my bones are fragile explains a lot about the fractures I have had over the years. I'm 50, have had cerebral palsy since birth and have been a c-6/7 quad for 19 years. In my case, the cp may be the greatest contributing factor to my bones. I can only imagine my bones as rendering me Humpty Dumpty.

I don't know if brittle bones can cause pain, but I have bone pain in places where I have little to no sensation. It's not neuro pain, but a deep bone pain.

Like you, I'm questioning the usefulness of having the DEX. No matter what it shows, it won't change my day to day life. If there are fractures, knowing will not change anything.

My doctors are pushing hard for me to have the scan. My feeling about it? Meh.

The one thing I am doing since learning about about the brittleness is being extremely cautious with all transfers. I don't need to jack up my body any more than its current jacked up state.

Yeah. "Meh" is how I feel. Yet I really feel hounded by this guy. Like you I'm aware of what can/does happen with bones and SCI, and I'm careful too. I just hate the scare tactics and the insinuation that the scan will provide some magical cure.

stephen212 · 08-03-2012, 03:41 PM

Quote:

Originally Posted by jck77

Yeah. "Meh" is how I feel. Yet I really feel hounded by this guy. Like you I'm aware of what can/does happen with bones and SCI, and I'm careful too. I just hate the scare tactics and the insinuation that the scan will provide some magical cure.

The question to ask is what does he plan on doing once the obvious results are documented. Why not have that conversation first and if the treatment options make any practical sense then you can proceed with scheduling a DEXA?

jck77 · 08-03-2012, 03:58 PM

That's great advice, Stephan, and I did try to ask. the answer was one of those vague sort of "we'll treat it from there" responses.

gjnl · 08-03-2012, 04:08 PM

Quote:

Originally Posted by jck77

Thanks GJ. I've already had the blood tests which show a low level of vitamin D. My old doc had me on a prescription Vitamin D, the new one thinks that OTC with calcium will do. I don't intend to do a standing program, although as you mention, I also did so for a while post injury. But again, how many levels of severity are there with osteoporosis that the drugs or the dosage could vary that much that the degrees need to be accurately and specifically measured? Do you see what I mean?

If your aren't opposed to treating osteoporosis and want to start therapy, your doctor needs this DXA as a baseline to assess your progress while you are on the drugs. Your doctor may start you out on one of the oral bisphosphonate drugs, Fosamax, Actonel, Boniva (or their generic equivelents). In a year maybe two, he will want you to have another DXA. At that time, he will determine if the oral bisphophonates are helping. Given what he finds, he may want to have you try one of the following:
Forteo - (teriparatide [rDNA origin] injection) Forteo is not a bisphosphonate. It is home administered once a day subcutaneous injections for two years
Prolia - (denosumab), a monoclonal antibody given by injection every six at a doctor's office;
Miacalcin - (Calcitonin-salmon) a synthetic thyroid gland hormone. It is administered by either nasal spray or injection;
Reclast (zoledronic acid), administered by venous infusion once a year.

The treatment of osteoporosis is based on how a patient tolerates drugs prescribed, risk of the drugs prescribed, and success of treatment over time as shown in follow up studies and tests.

All the best,
GJ

stephen212 · 08-03-2012, 04:22 PM

Quote:

Originally Posted by jck77

That's great advice, Stephan, and I did try to ask. the answer was one of those vague sort of "we'll treat it from there" responses.

It's not as though there are too many scenarios to consider in advance that would preclude having a discussion about the limited treatment possibilities. Sounds like a lazy thinking doc.

jck77 · 08-03-2012, 04:40 PM

I agree. Lazy is one way to put it. This is a physician who has a computer in front of him constantly, and who continually inputs data into whatever program he's using. Very little eye contact, no discussion about anything that does not relate to a physical phenomena. He can't remember from one time to next if I'm married, work, have children, etc., etc., but certainly has all the pat answers. Unfortunately, I can't find another doctor in the area who's taking new patients. That in itself probably speaks volumes.

Random · 08-03-2012, 04:45 PM

I take calcitonin, a totally innocuous (to me) nasal spray for bone density, safe for premenopausal women. I still have osteoporosis so don't know how much it's helping, but it can't be hurting.

jck77 · 08-03-2012, 04:54 PM

Random, I suppose I could look this up myself, but is this prescription or OTC? Thanks for the info.
Julie

gjnl · 08-03-2012, 05:05 PM

Quote:

Originally Posted by jck77

Random, I suppose I could look this up myself, but is this prescription or OTC? Thanks for the info.
Julie

Miacalcin - (Calcitonin-salmon) is by prescription. Depending upon the type of insurance you have and the case that can be made by your physician, you may have to run through a stepped process of taking osteoporosis drugs before insurance will pay for the newest and more expensive alternatives.

If this physician is your primary care physician or your gynecologist, you may be happier seeing an endocrinologist for treatment of osteoporosis. I don't think he will be any less likely to require a DXA scan before he begins treatment for osteoporosis, but you may be more satisfied with his approach and bedside manner than the doctor you are seeing for this now.

All the best,
GJ

SCI-Nurse · 08-03-2012, 08:15 PM

There is questionable value in getting most DEXA scans in persons with SCI or other forms of paralysis, for the following reasons:

Most DEXA machines are programmed only for doing bone density readings on the following areas: lumbar spine, wrist, and femoral neck. In people with SCI, it is common for those with even severe osteoporosis to have nearly normal bone density in these areas...in fact the lumbar spine may actually be MORE dense that in an AB person.

The most severe osteoporosis found in people with SCI is in the following areas (in order): distal femur, proximal tibia, proximal femur, and (in those with tetraplegia) the proximal humerus. Rarely are DEXA machines set up with the computer analysis data to scan these areas properly.

In addition, we have little information about actually effective treatment for either prevention or management of osteoporosis in people with SCI. Treatment such as is used for post-menopausal women is rarely effective. So you may end up with information that will tell you were you may be at risk for fractures, but rarely be able to do much about it.

(KLD)

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08-03-2012, 03:58 PM	#13
jck77 Member Join Date: Sep 2009 Location: Massachusetts Posts: 97	That's great advice, Stephan, and I did try to ask. the answer was one of those vague sort of "we'll treat it from there" responses.

08-03-2012, 04:40 PM	#16
jck77 Member Join Date: Sep 2009 Location: Massachusetts Posts: 97	I agree. Lazy is one way to put it. This is a physician who has a computer in front of him constantly, and who continually inputs data into whatever program he's using. Very little eye contact, no discussion about anything that does not relate to a physical phenomena. He can't remember from one time to next if I'm married, work, have children, etc., etc., but certainly has all the pat answers. Unfortunately, I can't find another doctor in the area who's taking new patients. That in itself probably speaks volumes.

08-03-2012, 04:45 PM	#17
Random Senior Member Join Date: May 2006 Location: Central NJ Posts: 2,203	I take calcitonin, a totally innocuous (to me) nasal spray for bone density, safe for premenopausal women. I still have osteoporosis so don't know how much it's helping, but it can't be hurting.

08-03-2012, 04:54 PM	#18
jck77 Member Join Date: Sep 2009 Location: Massachusetts Posts: 97	Random, I suppose I could look this up myself, but is this prescription or OTC? Thanks for the info. Julie

08-03-2012, 08:15 PM	#20
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,362	There is questionable value in getting most DEXA scans in persons with SCI or other forms of paralysis, for the following reasons: Most DEXA machines are programmed only for doing bone density readings on the following areas: lumbar spine, wrist, and femoral neck. In people with SCI, it is common for those with even severe osteoporosis to have nearly normal bone density in these areas...in fact the lumbar spine may actually be MORE dense that in an AB person. The most severe osteoporosis found in people with SCI is in the following areas (in order): distal femur, proximal tibia, proximal femur, and (in those with tetraplegia) the proximal humerus. Rarely are DEXA machines set up with the computer analysis data to scan these areas properly. In addition, we have little information about actually effective treatment for either prevention or management of osteoporosis in people with SCI. Treatment such as is used for post-menopausal women is rarely effective. So you may end up with information that will tell you were you may be at risk for fractures, but rarely be able to do much about it. (KLD)