Dexa Bone Density Axial Skeleton with TBS on 18 November 2024

Below are the results of my latest DXA scan and my first TBS. I am so excited about my TBS showing normal bone microarchitecture! 

The only value that was slightly worse than my previous scan of 18 August 2022, was my left femoral neck BMD of 0.728 g/cm2 and a T-score of -1.1 (osteopenia) in 2024, compared to left femoral neck BMD of 0.741 g/cm2 and a T-score of -1.0 (normal density) in 2022. 

For almost a year and a half (3/5/2023 through 8/17/2024), I reduced my daily dosage of strontium citrate from 682 mg of strontium per day to 341 mg 4X per week and 682 mg 3X per week. I resumed the full dosage on 8/18/2024. 

Impression

Based on BMD criteria, the patient has osteopenia. 

Based on the lumbar spine TBS data, the patient has a normal bone microarchitecture compared to the reference population. 

The patient's associated BMD and TBS values suggest a moderate resilience to fracture. 

Follow up with DEXA and TBS: 2 years 

WHO CRITERIA FOR T-SCORES: 

< or = -2.5 = osteoporosis 

< -1.0 and -2.5 = osteopenia

> or = -1.0 = normal density 

TBS scores: 

>1.31: normal bone microarchitecture

<1.31 and >1.23: partially degraded microarchitecture 

<1.23: degraded microarchitecture 

Narrative

EXAM: DXA AXIAL 

INDICATION: Postmenopausal. Risk factors for osteoporosis include [advanced age 

COMPARISON: 8/18/2022 

FINDINGS: 

Spine: Total BMD of the spine L1-4 is 1.129 g/cm2, with a T-score of 0.7 and a Z-score of 3.2. The lumbar spine trabecular bone score (TBS) is 1.521.

Left Femoral Neck: BMD is 0.728 g/cm2, with a T-score of -1.1 and a Z-score of 1.1. 

Left Total Hip: BMD is 0.842 g/cm2, with a T-score of -0.8 and a Z-score of 1.1. 

Right Femoral Neck: BMD is 0.754 g/cm2, with a T-score of -0.9 and a Z-score of 1.3. 

Right Total Hip: BMD is 0.900 g/cm2, with a T-score of -0.3 and a Z-score of 1.5. 

Diffuse increased 10% in the lumbar spine 

FRAX (adjusted for TBS if available) evaluation calculates 10-year probability of fracture: 

Major Osteoporotic: 8.7% 

Hip: 1.7%

Strontium, Osteoarthritis, and Reduced Dose of Strontium Citrate

Some research has suggested that strontium may boost the formation of collagen and cartilage in joints. In clinical studies, strontium ranelate seemed to reduce the progression of osteoarthritis (OA).

A year and a half ago, I reduced my daily dosage of strontium citrate from 682 mg strontium to 341 mg 4X per week and 682 mg 3X per week. Since then, I have developed the following:

1. A myxoid cyst, or digital mucus cyst, on my left thumb: A mucus cyst is a small, noncancerous bump usually found near a joint at the end of a finger. Such cysts are often found on the fingers of people with OA. Hot compresses may help shrink these cysts. 

2. Temporomendibular joint disorder (TMD): I have had a few, mild, temporary flare-ups of TMD in years past, but this flare-up is quite painful and not easing up after a couple of weeks. I may have brought it on by eating dry papaya slices, which were tough and chewy. I may be clenching my jaws at night due to stress. The pain is worse just after I wake up in the morning. Most likely, my TMJ disorder is due to progressing OA. 

Because of these two physical changes, I am resuming strontium citrate (SrC) at the full dose of 682 mg elemental strontium per day. Also, there was no reason to cut back the dosage in the first place because I was not having any adverse events from the strontium, and osteoporosis is a chronic condition--as is osteoarthritis. I didn't realize I have OA until I reduced my SrC, which was probably keeping the disease in check. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6040865/

https://academic.oup.com/mr/article-abstract/24/6/881/6302017?redirectedFrom=fulltext

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3791090/

How to Prepare for an Echolight REMS Scan

1. Wear loose fitting shorts. During cold weather, you can bring shorts with you.

2. Avoid eating a meal or drinking 2-3 hours before your scan.

3. Use the bathroom before the scan. 

Instructions courtesy of Ray Hinish, Pharm.D., Echolight Maryland at OsteoCoach

Sometimes Less Is More

I take several supplements. Recently, I have reduced the dosage or eliminated some of them.

AOR Strontium Support II, 341 mg strontium (from citrate)/capsule

Reduced from two capsules (682 mg Sr)/day to one capsule/day for four days/week and two capsules/day for three days/week

Reason: My DXA scan of August 18, 2022 showed "normal" bone density. Due to the bone strontium effect, my BMD is more likely at the osteopenia stage. Sure beats osteoporosis! 

Magnesium glycinate 

For about a year and a half, I took one capsule per day of Innate Vitality Magnesium Glycinate, 500 mg/capsule. The label does not give the amount of elemental magnesium, which would be 70.5 mg (14.1% of 500 mg magnesium glycinate). I think it is misleading to not provide the amount of Mg. I switched to Doctor's Best High Absorption Magnesium Glycinate Lysinate, which has 100 mg of Mg from 1000 mg magnesium lysinate glycinate chelate per tablet.  

Eliminated magnesium glycinate 

Reason: I was having multiple bowel movements with Doctor's Best, although not with Innate Vitality. There is Mg in my calcium supplement and my multivitamin. I also eat magnesium-rich foods. My husband is still taking Doctor's Best magnesium.

Horbaach Sublingual Methylcobalamin (Vitamin B-12), 5000 mcg/tablet

I was taking 5000 mcg/day, which is a huge amount. I knew it was a huge amount, but my husband needs that amount of B-12 to keep from getting canker sores. He got recurrent sores until he found out about B-12 for canker sores from a scientific article. More recently, I read that, in some people, B-12 can worsen acne because Propionibacterium acnes (P. acnes) need B-12. I have always had acne-prone skin. 

Reduced from one tablet/day to one tablet/week. My husband still takes it daily.

Reason: Worsening acne flareups, and recommended doses are much lower than I was taking

Probiotic, Various Brands

Eliminated probiotic. 

Reason: Not sure the ones I tried were helping my gas and bloating. For many years, I used Nature's Way Primadophilus Bifidus, which seemed to help my digestion. It had to be mailed overnight with a cold pack, but many vendors, such as Amazon, are not keeping it cold.  

Digestive Enzymes, Various Brands

Eliminated digestive enzymes

Reason: None of the various brands made a noticeable difference for my gas and bloating. I am not lactose intolerant. If I were, I would take Lactaid, or a generic lactase supplement, as my husband does. 

Sites Providing REMS Echolight Scans in USA

Radiofrequency Echographic Multi Spectrometry (REMS) Echolight is a new, radiation-free technology for assessing bone density and quality at the lumbar spine and femoral neck. US headquarters are located at 509 Madison Ave, RM 1510, New York, New York 10022. Below are the sites offering the scans in the USA. Echolight has a map of REMS centers in the USA. https://www.echolightmedical.com/en/find-your-rems-center-in-usa/

Arizona

OsteoStrong Arcadia, AZ

3301 E Indian School Rd, Suite 101, Phoenix, AZ 85018

https://www.precisionboneimaging.com/book-now

OsteoStrong Sedona, AZ

Safeway Plaza, 2370 W State Rte 89A, Suite 4, Sedona, AZ 86336 

https://www.precisionboneimaging.com/book-now

URPrecious 3D Breast Ultrasound 

9300 E Raintree dr, suite 130,
Scottsdale, AZ, USA 85260

Phone 602-878-7501

Radiologist: Meghna Krishnan MD

https://www.3dbreastultrasound.com/rems-echo-light.html

California

Anatara Medicine, 1700 California Street, Suite 520, San Francisco, CA 94109, phone 415-360-6355, Dr. Ahvie Herskowitz

Hydrate Wellness, contact David Perez, 613 Westlake Street, Suite 125B, Encinitas, CA 92024, phone 858-2424 (Encinitas is in San Diego county.)

OsteoStrong Brea, CA

OsteoStrong, Los Gatos, CA, contact Natasha Galkina, 786 Blossom Hill Road, Suite B, Los Gatos CA 95032, phone 408-596-9504

OsteoStrong Palm Desert, CA

OsteoStrong Porterville, CA

OsteoStrong Sacramento, CA

OsteoStrong San Diego, CA

OsteoStrong San Jose, CA

OsteoStrong Santa Barbara, CA

OsteoStrong Studio City, CA

https://www.precisionboneimaging.com/book-now

Coming soon:

OsteoStrong Brentwood Wilshire, Los Angeles, CA

OsteoStrong Mar Vista, Los Angeles, CA

OsteoStrong Torrance, Los Angeles, CA

OsteoStrong South Pasadena, CA  

https://www.precisionboneimaging.com/book-now

Florida

• USF Health and Tampa General Medical Group, Diabetes and Endocrinology, has three locations. The TGH Brandon Healthplex lists REMS.

TGH Brandon Healthplex

Clinics
Endocrinology Day Hospital
DXA
REMS

10740 Palm River Rd
Tampa, FL 33619
4th Floor

Appt: (813) 821-8011

https://health.usf.edu/care/diabetes-endocrinology/locations

 

Screen My Bones

3341 Tamiami Trail North

Naples, FL 34103

305-998-6008

https://screenmybones.us/

Dr. Krystyna Shepetiuk travels around the State of Florida with her Echolight and performs scans in various locations, including Osteostrong facilities. She may be visting Osteostrong in Lake Mary, Florida some time this summer (2024). 

Hawaii

Osteostrong Hawaiikai

Jeff and Jolee Hehn

6700 Kalanianaʻole Hwy, Honolulu Honolulu HI 96825

Idaho 

OsteoStrong Boise

600 N Steelhead Way, Suite 164, Boise, ID

(208) 331-4072

 Illinois

• SMaRT Institute - The Sports Medicine and Regenerative Therapeutics 

Dr Metthew E. Vogt 

12 Salt Creek Ln #300, Hinsdale, IL 60521

+1 630-922-5071

https://www.thesmartinst.com/home.html

• OsteoStrong of Greater Chicago, Inc 

Marc Malizia 

126 Skokie Blvd, Wilmette Illinois 60091

001 224-487-8833/ 224-408-2383

wilmette@osteostrong.me

Maryland

OsteoCoach Center for Strong Bones, 10210 S Dolfield Road, Owings Mills, MD 21117, phone 410-204-2904, Ray Hinish, Pharm.D.; Heidy Garcia, CPT 

https://appointments.osteocoach.com/booking?service=4

Rheumatology Associates of Delmarva, 505 Dutchmans Lane, Suite A3, Easton, MD 21601, phone 410-819-6545, Drs. Ed McLaughlin and Curtis Foy

New Jersey

• XBody Health, Wellness and Spa 

87 Berdan Ave, Suite 3 - 07470 Wayne, NJ 

973-692-9780

North Carolina

• Dr Andy Bush (Orthopedic Surgeon) 

Central Carolina Orthopaedic Associates 

Sanford, NC 

919-774-1355 (ask for James) 

• StrengthX 

Dr Mike Lewen (Chiropractor, Exercise Science) 

411 W State Street 

Black Mountain - Asheville NC 

828-505-7200

info@strengthx.me

Oregon

OsteoStrong Central Oregon, Bend, OR, Anne-Marie Amos (owner), phone 541-241-7067

OsteoStrong Happy Valley, 112111 SE 82nd Ave., Suite K, Happy Valley, OR 97086, phone 503-575-9845, email appointments@osteostronghappyvalleyor.com (Happy Valley is a suburban city in the Portland, OR metropolitan area.)

https://osteostrongpdx.com/free/

Pennsylvania

• Z Medical Solution (Dr Kimberly Zambito) 

27 Opal Court – 18940 Newtown PA

zmedicalsolutionllc@gmail.com

267-753-9933

Texas

• AOCBV (Arthritis & Osteoporosis Clinic of Brazos Valley) 

Dr Ricardo Pocurull 

College Station, TX 

979-696-8000

• Covenant Wellness 

Jackie DeVilliers, RN, BSN 

4014 22nd Place, Building 67, Suite 9 

Lubbock, TX 79410

(806) 725-6543

jdevilliers@covhs.org

• Thermography Center of Dallas 

Dr Michael Einsohn 

5529 Spring Valley Road 

75254 Dallas, TX 

+1 972-999-1765

thermography@thermographycenter.com

https://www.thermographycenter.com/

Echolight Scans Are Not Affected by Bone Strontium Content!

We strontium users know that BMD results by DXA scan will be artificially high, especially after years of using strontium salts. Here is good news! Echolight REMS technology is NOT AFFECTED by STRONTIUM. It uses ultrasound instead of ionizing radiation. Echolight is a modern ultrasound device capable of measuring bone at the hip and the spine using Radiofrequency Echographic Multi Spectrometry (REMS).

BMD measured by ultrasound is not affected by the strontium content of bone. An in vitro study concluded that aBMD measured by DXA was prone to overestimation in the presence of strontium, but acoustic parameters measured by quantitative ultrasound (QUS) are independent of strontium concentration.

https://pubmed.ncbi.nlm.nih.gov/29080282/

Another advantage of Echolight scans is that they assess the bone internal micro-architecture.  So, physicians obtain results of bone quantity and quality. 

Yet another advantage of REMS over DXA is that REMS appears to be able to overcome common artifacts such as structural alterations caused by OA (osteoarthritis) at the lumbar spine, which affect the BMD values obtained by DXA

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10217295/#:~:text=Radiofrequency%20Echographic%20Multi%20Spectrometry%20(REMS,technique%20present%20in%20the%20literaturePMC10217295

Echolight has received 510(k) clearance to sell its EchoS Systems in the USA! Companies must submit a Premarket Notification, also called a PMN or 510(k), to the FDA so that it can review the product and clear it. Once the FDA declares that a new medical device is substantially equivalent to a predicate, it is cleared and can be marketed and sold in the USA. 

Echolight has opened a headquarters in NYC. The scans are not available everywhere. You will have to shop around. One early adopter is Dr. Andrew Bush, M.D., an orthopedic surgeon with a practice that performs Echolight scans in Sanford, North Carolina.

https://www.centralcarolinaortho.com/Blog/374362/EXPLORING-ECHOLIGHT-A-NOVEL-WAY-TO-MONITOR-OSTEOPOROSIS

COPA Healthcare LLC, Dania, FL sells the EchoS/Echolight and Marodyne LiV. The website includes a video that shows the EchoS equipment and how the scan is done. The website makes it easy to leave a message in case you have questions.

https://copahealth.us/echolight/