Osteoporosis Treatment: DXA Results and Vitamin D Needs

DXA spine shows the lowest T-score of -1.8, and both femurs have a T-score of -2.2 (report from December 2012)?

DXA results show a lumbar spine T-score of -1.8 and a bilateral femur T-score of -2.2 (report from December 2012).
Dr.
Chen Yong-hsueh's recommendations are as follows:
1.
I have never had a fracture; does this mean that health insurance will not cover osteoporosis medication? Yes, health insurance does not provide unlimited coverage.
Currently, coverage is available only for individuals aged 60 and above with a bone mineral density (BMD) of less than -2.0 and normal kidney function.
2.
Do I need to proactively pay for treatments like bone stabilizers or oral medications? Yes, it is advisable to consider self-paying for these treatments.
Maintaining a normal diet, exercise, and sleep is crucial.
Whether to self-pay 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, individuals with normal kidney function can synthesize it through sunlight exposure.
If kidney function is poor, there are parathyroid abnormalities, or if there are concerns about vitamin D levels, a blood test to check vitamin D levels is recommended.
Thank you.
4.
I have a special situation where I rarely get sunlight; how much vitamin D should I take daily in IU? Dr.
Chen Yong-hsueh recommends that you should still try to get some sunlight.
If there are other conditions preventing normal vitamin D synthesis, please get a blood test to check your vitamin D levels and adjust accordingly.
Generally, about 600 IU per day is recommended.
5.
If I avoid strong sunlight between 10:00 AM and 4:00 PM and only go out when the UV index is low (1, 2, or 3) for about 15 minutes, is that sufficient? If that is sufficient, do I still need to supplement with an additional 600 IU of vitamin D? Thank you, doctor.

ERIC, 30~39 year old female. Ask Date: 2020/04/24

Dr. Chen Yongxue reply Orthopedics

If you have any questions, please visit the outpatient clinic for a blood test.
Thank you.

Reply Date: 2020/04/24

More Info

Osteoporosis is a condition characterized by decreased bone density and increased risk of fractures. The DXA (Dual-Energy X-ray Absorptiometry) scan results you provided indicate a T-score of -1.8 for the spine and -2.2 for the hip. These scores suggest that you are in the osteopenic range, which is a precursor to osteoporosis. While you have not experienced any fractures, the T-scores indicate that your bone density is lower than optimal for your age group.

In the United States, the guidelines for osteoporosis treatment typically require a T-score of -2.5 or lower for a diagnosis of osteoporosis, along with a history of fractures, to qualify for insurance coverage for medications. Since your scores are not below -2.5, you may not qualify for medication coverage under most insurance plans unless you have other risk factors or a history of fractures.

Regarding the need for self-funded treatments such as Forteo (teriparatide), it is essential to consider your overall health, lifestyle, and risk factors. Forteo is a bone-building medication that can be beneficial for individuals with osteoporosis, but it is typically reserved for those with more severe cases or those who have already sustained fractures. If you are concerned about your bone density and wish to take proactive measures, discussing the option of self-funding such treatments with your healthcare provider is advisable.

As for calcium and vitamin D supplementation, these nutrients are crucial for bone health. The recommended dietary allowance (RDA) for calcium for adults is about 1,000 mg per day, increasing to 1,200 mg for men over 70 and women over 50. Foods rich in calcium include dairy products, leafy greens, and fortified foods. If your diet is lacking in these foods, a calcium supplement may be beneficial.

Vitamin D is essential for calcium absorption and bone health. The RDA for vitamin D is 600 IU for adults up to age 70 and 800 IU for those over 70. If you have limited sun exposure, which is common in individuals who work indoors or live in areas with less sunlight, you may need to supplement with vitamin D. A blood test can help determine your vitamin D levels, and if they are low, your healthcare provider may recommend a higher dosage.

Regarding your question about sun exposure, if you are avoiding the sun during peak hours (10 AM to 4 PM), you can still obtain vitamin D by exposing your skin to sunlight for about 15 minutes a few times a week. However, if your sun exposure is minimal, you may still need to take a vitamin D supplement to reach the recommended levels.

In summary, while your current DXA results do not indicate osteoporosis, they do suggest that you are at risk for developing it. Regular monitoring of your bone density, maintaining a balanced diet rich in calcium and vitamin D, and engaging in weight-bearing exercises are essential steps in managing your bone health. If you have concerns about your bone density or overall health, it is crucial to have an open discussion with your healthcare provider to tailor a plan that suits your needs.

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