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Topic: Scoliosis and DEXA

Forum: Bone Health and Bone Loss —

Talk with others about bone density, osteopenia and osteoporosis, and ways to keep your bones strong

Posted on: Aug 22, 2014 01:17PM

Momine wrote:

Just had another DEXA, because I am on femara/letrozole, and I am trying to prepare for meeting with the onc in a few weeks.

My hip is fine at -0.1, where it has been for the last two years.

Spine is not so good. The total score is -2.3, with one vertebra (L4) all the way down at -2.9.

The difference between the two scores is apparently considered significant by bone docs (although not by my onc, who seems to know very little about bones).

Upon reading, I find out that spine DEXA is not considered accurate in people with scoliosis. Scoliosis can cause the measurement to become "spuriously" depressed, i.e. scoliosis can make it look like your bones are worse than they really are.

The reason is that the bone mass is measured as a ratio, where one factor is the area of bone. When the spine is twisted, the area looks larger than it is (because you view it slightly from the side instead of straight on), making the density look lower than it is.

Does anyone else have any experience with this? If DEXA is not accurate on a spine with scoliosis, how do you decide if the spine is OK? I do not want my spine to collapse, but I also don't want to take major drugs unnecessarily.

Dx 6/1/2011, ILC, 5cm, Stage IIIB, Grade 2, 7/23 nodes, ER+/PR+, HER2- Chemotherapy 6/20/2011 Cytoxan (cyclophosphamide), Ellence (epirubicin), Fluorouracil (5-fluorouracil, 5-FU, Adrucil), Taxotere (docetaxel) Surgery 9/13/2011 Mastectomy: Left, Right Radiation Therapy 1/9/2012 Surgery 3/8/2012 Prophylactic ovary removal Hormonal Therapy 4/1/2012 Femara (letrozole)
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Aug 22, 2014 11:54PM coraleliz wrote:

I wonder if there is a "specialist" who can help sort this out. In your reading, what were the specialties of those being quoted or writing. This is good to know. I also have scoliosis. I've also heard that the DEXA is not accurate in petite women. That was defined as 5ft4in or less. Post back if you find anything more.

Dx 2/28/2011, IDC, Right, 1cm, Stage IA, Grade 1, 0/5 nodes, ER+/PR+, HER2- Dx 3/15/2011, IDC, Left, 1cm, Stage IIA, Grade 1, 2/4 nodes, ER+/PR+, HER2- Surgery 4/15/2011 Lymph node removal: Left, Right, Sentinel; Mastectomy: Left, Right
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Aug 23, 2014 03:15AM Momine wrote:

Coraleliz, I have the name of a big-time osteoporosis specialist, and I will try to get in to see him. I tried an ortho, a highly recommended and experienced ortho, but he did not have much to offer by way of wisdom.

The other thing I gleaned from my reading is that performing and interpreting DEXAs may fall more in the realm of art than science, especially when there are complicating factors, like scoliosis. This leads me to think that having a highly experienced and careful radiologist performing and interpreting the DEXA may help a great deal. I found such a person near me, and I am planning to ask him to look at my scans for a second opinion.

I'll keep this thread in my "favorites" so if you learn something new, please add it as well (as will I).

Dx 6/1/2011, ILC, 5cm, Stage IIIB, Grade 2, 7/23 nodes, ER+/PR+, HER2- Chemotherapy 6/20/2011 Cytoxan (cyclophosphamide), Ellence (epirubicin), Fluorouracil (5-fluorouracil, 5-FU, Adrucil), Taxotere (docetaxel) Surgery 9/13/2011 Mastectomy: Left, Right Radiation Therapy 1/9/2012 Surgery 3/8/2012 Prophylactic ovary removal Hormonal Therapy 4/1/2012 Femara (letrozole)
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Aug 23, 2014 04:37AM Heidihill wrote:

I haven't had a DEXA in three years but I've been on Tamoxifen which is supposed to help with bones. My last DEXA (while on Femara and Zometa)  showed above average at all points which was better than they were pre-cancer. I also have scoliosis. My last PET/CT showed slight lumbar spine degradation but didn't compare it with previous scans. I'm OK with "slight." This is not a ratio so something more concrete, I guess.   

Dx 8/2007, IDC, Left, 2cm, Stage IV, metastasized to bone, Grade 2, 2/19 nodes, mets, ER+/PR+, HER2- (FISH) Hormonal Therapy 3/25/2015 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Aug 23, 2014 11:50AM Momine wrote:

Heidi, that is good to know. Thanks for weighing in. Apparently there is a a kind of CT that is used when DEXA is deemed not fit for the task.

Dx 6/1/2011, ILC, 5cm, Stage IIIB, Grade 2, 7/23 nodes, ER+/PR+, HER2- Chemotherapy 6/20/2011 Cytoxan (cyclophosphamide), Ellence (epirubicin), Fluorouracil (5-fluorouracil, 5-FU, Adrucil), Taxotere (docetaxel) Surgery 9/13/2011 Mastectomy: Left, Right Radiation Therapy 1/9/2012 Surgery 3/8/2012 Prophylactic ovary removal Hormonal Therapy 4/1/2012 Femara (letrozole)

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