CD & osteoporosis, bone density DXA, DEXA etc

DEXA scan information


Posted by Eileen on 7/9/2006

GF board

DEXA scan information

Here's a link giving info on the DEXA scan....



Link: www.radiologyinfo.org/en/info.cfm?pg=dexa&bhcp=1

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Conversion of standard deviations (T and Z scores)

….there are tables that allow an easy conversion of standard deviations to percentages. For example, a Z-Score of -1.8 means that patients at the 4th percentile, or 96% of women in that category, have greater bone density than the patient. A T-Score of -2.0 means a patient at the 2nd percentile, or 98% of pre-menopausal women have greater bone density than the patient. A T-score between -1 and -2 represents significant bone loss or osteopenia. The World Health Organization considers a T-Score of -2.5 or below to signify osteoporosis. And many U.S. organizations deem -2.0 or below to represent osteoporosis.

www.altoonaarthritis.com/services/bonedensity.asp

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From Calor:

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DEXA Scan

Note: The information below is a general guide only. The arrangements, and the way tests are performed, may vary between different hospitals and doctors. Always follow the instructions given by your local hospital or doctor relating to any test or procedure.

A DEXA scan is used to measure the density of bones. It is mainly used to diagnose osteoporosis (loss of bone material) and to assess your risk of having a fracture.

What is a DEXA scan and what does it measure?
DEXA stands for 'dual energy x-ray absorptiometry'. It is a test that measures the density of bones. In general, the more dense the bone, the stronger it is, and the less likely it is to break.

How does a DEXA scan work?
A DEXA scan uses low energy x-rays. A machine sends x-rays from two different sources through the bone being tested. Bone blocks a certain amount of the x-rays. The more dense the bone is, the fewer x-rays get through to the detector. By using two different x-ray sources rather than one it greatly improves the accuracy in measuring the bone density.
The amount of x-rays that comes through the bone from each of the two x-ray sources is measured by a detector. This information is sent to a computer which calculates a score of the average density of the bone. A low score indicates that the bone is less dense than it should be, some material of the bone has been lost, and is more prone to fracture.
How is a DEXA scan done?
You lie on your back on a couch and are asked to keep still while an x-ray detector (the 'scanner') comes over the area to be tested. An x-ray machine fires x-rays towards the detector. The bones commonly scanned are the vertebrae (back bones), hip and wrist. (These are the bones that most commonly fracture due to osteoporosis.) The scan is painless and takes 10-15 minutes. You do not need to do any special preparation prior to a DEXA scan.

Who should have a DEXA scan?
A DEXA scan may be advised if you are at increased risk of osteoporosis. Osteoporosis usually causes no symptoms at first. However, if you have osteoporosis, you have an increased risk of breaking a bone. (See the leaflet on osteoporosis for more details.) If a DEXA scan shows that you have osteoporosis, then you may be given advice and treatment to help strengthen your bones. Therefore, a DEXA scan may be advised if you have:
a fracture following a minor fall or injury.
loss of height due to fracture of a vertebra (back bone).
taken steroid tablets for three months or more.
an early menopause (aged less than 45).
a history of periods stopping (amenorrhoea) for more than one year before the menopause.
other disorders associated with osteoporosis such as rheumatoid arthritis or coeliac disease.
a family history of hip fracture on your mothers side.
a body mass index of less than 19. (That is, if you are very underweight.)

www.patient.co.uk/showdoc/27000476/


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From BUPA

DEXA scan
What do the results of the scan mean?
The results of the scan are a measure of how your bone density compares to the normal average for young, healthy adults.

Explanation
When you have your scan, you will be given what is known as a T score. This is a measure of how much your bone density differs from the average for young, healthy adults, whose bone mineral density is at its peak.
If your T score is between:
0 and -1, your bone density is normal
-1 and -2.5, this is classed as osteopenia - this means your bone density is a bit lower than normal, but you don't yet have osteoporosis
below -2.5, this is classed as osteoporosis
You may sometimes be given a Z score when you have your scan. This is a measure of how your bone density compares to the average for people of your own age. This score isn't used to diagnose osteoporosis, but is sometimes used by doctors to assess treatments in older people or in children, when it would not be relevant to compare scores with the average for a young adult.
Sources
Bone density scanning. National Osteoporosis Society, December 2005. www.nos.org.uk



What will happen if I'm classed as having osteopenia?
Your GP will probably advise you to make some lifestyle changes, if you're diagnosed with osteopenia after having a DEXA scan.
Explanation
Having osteopenia means you have a lower bone density than normal, and could be at risk of progressing to osteoporosis. If you're given a diagnosis of osteopenia after your DEXA scan, your doctor will probably suggest you make some lifestyle changes. This is to slow down the possible progression to osteoporosis and therefore reduce your risk of breaking a bone. The lifestyle changes may include the following.
Including more calcium in your diet. Foods that are high in calcium include milk, hard cheese, yogurt, sardines and white bread. Your doctor may advise you to take vitamin D supplements, as vitamin D helps calcium to be absorbed into the body.
Carrying out regular, low-impact, weight-bearing exercise, such as walking.
Stopping smoking.
Not drinking too much.
You won't usually be prescribed medicine if your bone density is not low enough for you to be diagnosed with osteoporosis. However, you may be advised to have another scan two to five years later, to check on your progress.
Sources
Bone density scanning. National Osteoporosis Society, December 2005. www.nos.org.uk
Osteoporosis. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 19 September 2008



Will I have a repeat DEXA scan to check if my treatment is working?
You will usually only need to have another scan if you break a bone (after only a minor bump or fall), despite being on treatment for at least two years.
Explanation
If you have not broken any bones while taking treatment for osteoporosis, this is thought to be enough proof that your treatment is working well. It's usually not necessary to have another DEXA scan just to check up on your progress.
However, if you do break a bone after you have been taking treatment for osteoporosis for at least two years, you may be advised to have a repeat scan. You won't usually be offered a scan if you break a bone while on treatment for less time than this, as it can take up to two years for the treatment to have a beneficial effect on your bones. If a repeat scan shows that your bone mineral density is still below normal, your doctor may switch you to another type of treatment.
If you feel that you would like a repeat scan and you're not entitled to one on the NHS in your area, it's sometimes possible to arrange to have one privately. However, you will still usually need to be referred by your GP.
Sources
Osteoporosis. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 19 September 2008
Bone density scanning. National Osteoporosis Society, December 2005. www.nos.org.uk



Will a scan on my heel show whether I have osteoporosis?
No, a DEXA scan carried out on your heel can't diagnose osteoporosis, as the bone density in your heel isn't always a good indication of whether you have the condition.
Explanation
Many devices are available that can measure the bone density of your forearm, heel, finger and hand. These devices are often seen as a cheaper and easier way to check your bone mineral density than the larger machines usually used in hospitals to diagnose osteoporosis.
However, your bone mineral density varies between different sites of your body. The bone mineral density of your hip is thought to be the best predictor of your risk of breaking a bone. This is why doctors usually take a measurement of bone mineral density at your hip to diagnose osteoporosis.
The bone mineral density of your heel can often be different from that of your hip, so it's not thought to be a very good indication of osteoporosis.
Doctors may sometimes suggest taking a DEXA scan of your heel or another part of your body as a 'first step' before deciding whether you should have a full DEXA scan.
Sources
Bone density scan. Radiological Society of North America. www.radiologyinfo.org, accessed 19 September 2008
Osteoporosis. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 19 September 2008
Management of osteoporosis. Scottish Intercollegiate Guidelines Network (SIGN), April 2004. www.sign.ac.uk
Bisphosphonates (alendronate, etidronate, risedronate), selective oestrogen receptor modulators (raloxifene) and parathyroid hormone (teriparatide) for the secondary prevention of osteoporotic fragility fractures in postmenopausal women. National Institute for Health and Clinical Excellence (NICE), January 2005. www.nice.org.uk


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Re: Osteoporosis

Posted by GFT on 15/3/2017....
GF board

Once you have your latest DEXA results, you could also use the Fracture Risk Assessment Tool - FRAX and see what your risk of fracture is:

www.shef.ac.uk/FRAX/tool.aspx?country=1

British Society of Gastroenterology

The Management of Adults with Coeliac Disease
_____________________________________________________________________
Ciclitira P J, Dewar D H, McLaughlin S D, Sanders DS
_____________________________________________________________________


8.10 Osteoporosis
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All patients should have bone density measured at presentation (by DEXA scan).
Females with normal bone density at presentation should be re-assessed after the menopause (and males at age 55).
Those with abnormal bone density should be re-assessed every three years.
Osteoporosis should be actively treated according to published guidelines.
All individuals with coeliac disease should be advised to consume 1500 mg calcium per day and adopt other conservative measures to reduce risk of osteoporosis.
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Alendronic Acid tablets

Posted by Sue on 29/11/2011

GF board

Hope you can all help and advise me and apologies as I guess this has been discussed before.
I have been diagnosed Coeliac for 9 yrs and upped the calcium in my diet on diagnosis. I have had 3 bone scans and the last one showed that in spite of a good level of calcium in my diet and being put on 2 Calcichew a day about 6 months before the last scan, my bones have deteriorated and I now have Osteopaenia. As I also have M.E. I am unable to do any weight bearing exercise and although not housebound I can't get out every day for walks. My Gp was advised by Gastro to speak to a rheumatologist , he went off sick before doing so and so a locum has now done it and suggested Alendronic Acid (70mg a week).
I haven't been able to discuss it with them as the receptionist just rang and said to collect the prescription , but I really want advice before i go as i dont want them to think I am just being awkward. I am REALLY REALLY scared to take it as I had ulceration and gastritis when first diagnosed and also am EXTREMELY sensitive to any drugs I take and don't want to take anything that will upset my stomach again as i had enough of that pre diagnosis. However I do know how nasty osteoporosis is.
My Dentist has frightened me by saying that if you are on a dose of 70mg any extractions have to be done in hospital and he recently had a patient refused by the hospital and he had to argue for ages to get them helped (cutbacks to blame I suspect). Whilst I dont plan on having any teeth out, I dont relish being in pain and waiting while the dentist argues with the hospital.
Please can anyone who is or has taken it tell me their experience hopefully some good and (even though I am scared) bad as I want to be armed before i see the GP? Any advice about alternatives would be good too. Also if I do agree to take it when should I be asking for another scan?
Sorry for such a long post, but I know this is the best place to get some advice as i really am scared by this drug.







From Marina:

...also was diag with osteopaenia after a bone scan. Its in my left hip. I am not sure if it was the Hospital who advised my GP to put me on this drug. However I took it for about a month and the leaflet inside scared me. I did not feel myself and yet I could not pin it down to anything else. I just informed my GP that I wasnt happy with this drug and stopped. I was advised to up the Calcichew to 2 a day and to incorperate more Calcium in my diet. I do get a lot of exercise and am fit at 76 but cant wait for my next scan although this is not for about 18 months. We are all different and would hate to put you off taking the tablet but try and have a good talk with your GP. I do know someone else who hasnt had a problem taking Alendronic Acid . Why are we put though this worry I dont know


From Sandra;
...
I was in a similar situation as you before I was given Alendronic acid. I also had gastritis but the drug has not affected my stomach. I did have a tooth extracted at the dental hospital at the beginning of the year (I attend the Dental Hospital for other reasons)and it did take a lot longer for the socket to heal and the bone to shrink, but in saying that not really a big problem. Hope this helps your decision


From DebsPinkGF

... I was was prescribed this last year and did a lot of research into it. Obviously your situation may be different, but I flatly refused to take it and now refuse to see the doctor who prescribed it for me without fully looking into my history or advising me of any of the possible side effects. I would advise you to research as much as you can and don't make any rash decisions about taking it.




From Lily

These were once suggested to me as a treatment but after I read up on the possible side effects- including no reversal of certain undesirable symptoms once medication had stopped- I declined.

My bone density improves on simple calcium & Vit D supps so I'm prescribed them for life now (with HRT patches & dairy & tofu etc in diet).

Also please see:

coeliac.proboards.com/index.cgi?action=display&board=misc&thread=3520

J Womens Health (Larchmt). 2005 May;14(4):339-44.

The use of fingernails as a means of assessing bone health: a pilot study.

Pillay I, Lyons D, German MJ, Lawson NS, Pollock HM, Saunders J, Chowdhury S, Moran P, Towler MR.

Source
Department of Medical Gerontology, Clinical Age Assessment Unit, Limerick Regional Hospital, Dooradoyle, Limerick, Ireland. ipillay@hotmail.com

Abstract
BACKGROUND:
Anecdotally, patients volunteer reports of increasing hardness of their fingernails within months of starting diverse treatments for osteoporosis. The properties of both nail and bone may be linked in a comparable, measurable way.

METHODS:
We examined the fingernails of two groups of patients, with (n = 9) and without (n = 13) osteoporosis at either the hip or lumbosacral spine. We performed nanoindentation to assess the degree of nail brittleness and Raman spectroscopy to assess the disulfide bond content of nail.

RESULTS:
The mean moduli of fingernails of patients with low bone mineral density (BMD) are lower than those of patients with normal BMD. The mean difference in mean modulus between the groups was found to be 0.996 (p = 0.15 between groups). The spectroscopy data also showed differences between the two sets of nails. The disulfide bond content of the nails sourced from osteoporotic patients was lower than that from healthy patients (p = 0.06 between groups).

CONCLUSIONS:
Bone collagen and nail keratin are two distinct structural proteins, and both require protein sulfation and disulfide bond formation, via cysteine, for structural integrity. A disorder of either process may lead to disordered collagen and keratin synthesis. This is reflected in the structural abnormalities seen in clinical syndromes in which there is either protein deficiency, disorders of sulfur metabolism, or cystathione beta-synthase deficiency. The relationship between nail and bone may exist in a measurable way.
This pilot study should lead to further work to explore this relationship. Could nail prove to be a valuable adjunct to diagnosis or provide a means of more rapid follow-up after commencement of therapy?

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Crescent Diagnostics is an early stage diagnostics company incorporated in the UK, with a laboratory in Derry, Northern Ireland and offices at University College Dublin in the Republic of Ireland.
The company is a spin-out of the University of Limerick and founded upon research conducted by the Crescent co-founder Dr Mark Towler, currently Professor of Biomedical Engineering, Ryerson University, Toronto, Canada.
Crescent is led by CEO Brendan Farrell, a veteran of the diagnostic industry, and Chairman Barry Clare, a former main board director of Boots plc. Since its establishment Crescent has raised over Euro 4m, and its investors include Seroba Kernel, Kernel Capital, Enterprise Equity and Enterprise Ireland.

Crescent Diagnostics has developed BQT® (Bone Quality Test) as a screening technology for assessing the risk of osteoporosis. Osteoporosis represents a significant challenge around the world affecting one in three women and one in five men over fifty.
The cost of hip fractures resulting from osteoporosis is estimated at €36 billion annually to treat in the EU.

BQT® will be marketed as an over-the-counter test in the UK and the Republic of Ireland under the name Osentia®. It will be sold through pharmacies and other retail outlets and through the internet, using a consumer-to-lab business model.

BQT® analyses the keratin structure in nail clippings using Raman spectrometry.
The analysis of keratin is able to is able to differentiate between people showing a risk of fragility fracture and those that do not.

www.crescentds.com/company


More

crescentdx.com/category/news

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How coeliac disease adds to the risk of osteoporosis
Posted by Lily on 5/4/2014

GF board

How coeliac disease adds to the risk of osteoporosis

People tend to have lower BMD when they are first diagnosed with coeliac disease. This is because most people are diagnosed long after they reach their peak BMD in their mid twenties.

Coeliac disease is most often diagnosed in adults between the ages of 40 and 60. Research shows that the average time it takes for someone to get diagnosed with coeliac disease is 13 years. During that time your body will not be able to absorb important vitamins and minerals, including the calcium needed for strong bones.

If you are diagnosed with coeliac disease in your childhood or teens, and follow a gluten-free diet, your long term bone health is likely to be unaffected.

Your BMD will usually improve after starting a gluten-free diet.

Women diagnosed with coeliac disease after the menopause find it more difficult to improve their BMD. This is because there is less of the hormone oestrogen, which speeds up the loss of bone strength.

The risk of osteoporosis increases as you get older. There are also other factors that can make you more at risk of osteoporosis, including:

late or delayed diagnosis of coeliac disease in adult life
lapses from the gluten-free diet
lactose intolerance
being underweight
smoking....


...Following a healthy and balanced gluten-free diet that is rich in calcium is important to keep bones healthy.

People with coeliac disease have an increased need for calcium compared to the general adult population.

It is recommended that adults with coeliac disease have between 1000mg and 1500mg of calcium each day. The recommended intake of calcium for the general population is 700mg per day.

As an example, one third of a pint of semi skimmed milk has approximately 230mg of calcium....


www.coeliac.org.uk/coeliac-disease/associated-conditions-and-complications/osteoporosis/

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Also this on phosporus & osteoporosis
Posted by Sue L, Kent on 5/4/2014

www.ncbi.nlm.nih.gov/pubmed/14708952

Phosphorus nutrition and the treatment of osteoporosis.

...Bone mineral consists of calcium phosphate, and phosphorus is as important as calcium in supporting bone augmentation and maintenance. Although typical adult diets contain abundant phosphorus, 10% to 15% of older women have intakes of less than 70% of the recommended daily allowance. When these women take high-dose calcium supplements that consist of the carbonate or citrate salts, all their food phosphorus may be bound and hence unavailable for absorption. Current-generation anabolic agents for treating osteoporosis require positive phosphorus balances of up to 90 mg/d. Attention to the nutritional adequacy of the diets of such patients is essential if they are to realize the full potential of such therapies. A calcium phosphate supplement may be preferable to the usual carbonate or citrate salts because its phosphate serves to spare food phosphorus...

Re: How coeliac disease adds to the risk of osteoporosis

Posted by Sue L, Kent on 5/4/2014


Recently I came across an article that stresses the importance of phosphorus alongside calcium, which is important for me as several blood test results have come back with low levels of phosphorus. The UK seems pretty poor at including this in supplements so I am going to get an American brand of supplement for healthy bones.

Here is the link to the article I found.:

www.nutraingredients.com/Research/Calcium-supplements-should-contain-phosphorous-too-says-study

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Long-term effects of bisphosphonate therapy: perforations, microcracks and mechanical properties

Shaocheng Ma et al

Scientific Reports 7, Article number: 43399 (2017)

Abstract
Osteoporosis is characterised by trabecular bone loss resulting from increased osteoclast activation and unbalanced coupling between resorption and formation, which induces a thinning of trabeculae and trabecular perforations. Bisphosphonates are the frontline therapy for osteoporosis, which act by reducing bone remodelling, and are thought to prevent perforations and maintain microstructure. However, bisphosphonates may oversuppress remodelling resulting in accumulation of microcracks. This paper aims to investigate the effect of bisphosphonate treatment on microstructure and mechanical strength. Assessment of microdamage within the trabecular bone core was performed using synchrotron X-ray micro-CT linked to image analysis software. Bone from bisphosphonate-treated fracture patients exhibited fewer perforations but more numerous and larger microcracks than both fracture and non-fracture controls. Furthermore, bisphosphonate-treated bone demonstrated reduced tensile strength and Young’s Modulus. These findings suggest that bisphosphonate therapy is effective at reducing perforations but may also cause microcrack accumulation, leading to a loss of microstructural integrity and consequently, reduced mechanical strength.


www.nature.com/articles/srep43399

Drug used to treat weak bones associated with micro-cracks

Date:
March 1, 2017

Source:
Imperial College London

Summary:
A type of drug used to treat weak bones is associated with an increased risk of 'micro-cracks' in bone, according to new research.

...The early-stage research, by scientists at Imperial College London, suggests these microcracks may reduce mechanical strength of the bone.

In the study, published in the journal Scientific Reports, researchers studied bone samples from 16 people who had been diagnosed with the weak bone condition osteoporosis.

All of the patients had suffered a broken hip, and half of the patients had been taking a type of commonly-prescribed drug called bisphosphonate.

The team then used X-rays from the Diamond synchrotron to visualize the structure of bone at a high resolution.

They found that the bones of people taking the drugs not only had a larger number of tiny cracks, but also had less mechanical strength.

The team said there is now an urgent need to further investigate these findings -- though they stressed that patients should not stop taking the medication if they have been prescribed the drugs by their doctor.

Dr Richard Abel, lead author of the research from the Department of Surgery and Cancer at Imperial, said: "Although this is a very small, early-stage study, the results are quite startling, and justify follow-up studies....


www.sciencedaily.com/releases/2017/03/170301092704.htm