Osteoporosis Treatment and Calcium Needs After DEXA Scan Results - Orthopedics

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DEXA bone mineral density: spinal T-score -1.8, bilateral femoral T-score -2.2?


Your questions: Currently taking medications include LEEYO (Escitalopram) 10mg, Doxepin 25mg *2, LYRICA 75mg *2, Metformin 500mg, Tamsulosin 0.2mg, Ativan 0.5mg *4, Zolpidem *2 at bedtime (all taken long-term).
Dual-energy X-ray absorptiometry (DEXA) bone density test results show a spine T-score of -1.8 and a bilateral femur T-score of -2.21.
I have never had a fracture.
Does this mean that health insurance will not cover osteoporosis medication treatment? 2.
Is there a need for me to proactively pay out of pocket for bone strengthening injections or oral treatment medications? 3.
Do I need to take additional calcium and vitamin D supplements? How much calcium and vitamin D should I take daily? Thank you for your response, Doctor: Orthopedic Specialist, Dr.
Chen Yong-Hsueh suggests: 1.
Since I have never had a fracture, does this mean that health insurance will not cover osteoporosis medication treatment? Yes, health insurance cannot provide unlimited coverage.
Currently, one must be over 60 years old, with a bone density of <-2.0, and have normal kidney function to qualify for coverage.
2.
Is there a need for me to proactively pay out of pocket for bone strengthening injections or oral treatment medications? A normal diet, exercise, and sleep are the most important.
Whether you need to pay out of pocket depends on your financial situation.
3.
Do I need to take additional calcium and vitamin D supplements? How much calcium and vitamin D should I take daily? There are many calcium-rich foods, such as milk, soy milk, bone broth, small dried fish, cheese, and sesame seeds.
It is not strictly necessary to take calcium supplements.
As for vitamin D, it can be produced by the body through sunlight exposure in individuals with normal kidney function.
If there are concerns about kidney function, parathyroid abnormalities, or personal vitamin D levels, a blood test to check vitamin D levels can be performed.
Thank you, Doctor.
I have some additional questions.
3.
I have a special situation where I get very little sun exposure.
How much vitamin D should I take daily in IU? Thank you, Doctor.

ERIC, 30~39 year old female. Ask Date: 2020/04/16

Dr. Chen Yongxue reply Orthopedics


It is still advisable to get moderate sun exposure.
If there are other circumstances that prevent the normal synthesis of vitamin D, please consider getting a blood test to check vitamin D levels and adjust accordingly.
Generally, a daily intake of about 600 IU is recommended.

Reply Date: 2020/04/16

More Info


Osteoporosis is a condition characterized by decreased bone density and increased risk of fractures. Your recent DEXA scan results indicate a T-score of -1.8 for the spine and -2.2 for the femur, which suggests that you are at risk for osteoporosis, particularly in the femur region. A T-score of -2.5 or lower is typically used to diagnose osteoporosis, while scores between -1.0 and -2.5 indicate osteopenia, a precursor to osteoporosis. Given your scores, you are in the osteopenic range, which means you should take proactive steps to improve your bone health.

1. Insurance Coverage for Osteoporosis Treatment: In many healthcare systems, including those in the U.S., insurance coverage for osteoporosis medications is often contingent upon specific criteria. Typically, these criteria include age (often 60 years or older), a T-score of -2.0 or lower, and the absence of prior fractures. Since your T-score for the femur is -2.2, you may not qualify for insurance coverage unless you meet the age requirement or have other risk factors. Therefore, it is essential to discuss your situation with your healthcare provider to understand your options and whether you might qualify for any assistance.

2. Self-Paying for Treatment: If you do not qualify for insurance coverage, you may need to consider self-paying for osteoporosis treatments. There are several options available, including bisphosphonates (like alendronate or risedronate), denosumab, and hormone replacement therapy, among others. The decision to self-pay should be based on a thorough discussion with your healthcare provider, who can help you weigh the benefits and risks of each treatment option based on your specific health profile and financial situation.

3. Calcium and Vitamin D Supplementation: Adequate calcium and vitamin D intake is crucial for bone health. The recommended dietary allowance (RDA) for calcium is about 1,000 mg per day for adults up to age 50, and 1,200 mg for those over 50. For vitamin D, the RDA is 600 IU for adults up to age 70 and 800 IU for those over 70. However, since you mentioned that you have limited sun exposure, you may need to supplement your vitamin D intake. A blood test can help determine your current vitamin D levels, and based on that, your healthcare provider can recommend an appropriate dosage.
In terms of dietary sources, you can obtain calcium from foods such as dairy products (milk, yogurt, cheese), fortified plant-based milks, leafy green vegetables, and fish with bones (like sardines). Vitamin D can be found in fatty fish, fortified foods, and egg yolks, but supplementation may be necessary if dietary intake is insufficient.

4. Exercise and Lifestyle Modifications: Regular weight-bearing and muscle-strengthening exercises are vital for maintaining bone density. Activities such as walking, jogging, dancing, and resistance training can help strengthen bones and improve balance, reducing the risk of falls and fractures. Additionally, ensuring adequate sleep and managing stress are essential components of overall health that can indirectly support bone health.

In summary, your DEXA scan results indicate a need for attention to your bone health. While insurance coverage for osteoporosis medications may be limited based on your age and T-score, proactive measures such as dietary adjustments, potential supplementation, and lifestyle changes can significantly impact your bone density. It is crucial to work closely with your healthcare provider to develop a comprehensive plan tailored to your needs.

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