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Hello Doctor, Below Is A Medical Report For Bone Density
Question: Hello doctor,
Below is a medical report for bone density exam done several months ago. From that time to this time I am taking boniva 150 mg once monthly
Clinical Indication
67 year old patient, from Iraq, mild scoliosis, parental history of hip fracture, on no calcium, R/O osteoporosis.
Skeletal Region Bone density (g/cm2) SD* above or below the mean for young adults SD* above or below the mean for age- matched controls
AP spine (L3-L4) 0.669 -3.9 -1.9
Femur Total 0.793 -1.2 0.1
Femur Neck 0.574 -2.5 -0.5
Forearm (Radius 33%) 0.617 -1.3 0.6
*SD: standard deviation
Findings
BMD measurements reveal the presence of osteoporosis.
Noted on the scan image is the presence of mild scoliosis, sclerosis of L1 and L2, that may falsely increase bone mass. L1 and L2 were therefore deleted from analysis. X-rays of lumbar spine would be helpful to further characterize these changes. The patient trabecular bone score (TBS) an index of bone microarchitecture and an independent predictor of fracture, from L3-L4 is 0.96. TBS normative database derived using Caucasian population.
Risk Assessment
The TBS adjusted FRAX derived 10 year fracture risk, using FRAX Lebanon as a surrogate country, is 16.5% for major osteoporotic fracture (spine, hip, forearm, and humerus) and 5.3 % for a hip fracture. The 2013 Lebanese FRAX-based osteoporosis guidelines may be accessed on the following link http://www.aub.edu.lb/FM/CMOP/Pages/LebaneseGuidelines.aspx. These guidelines do not supersede clinical judgment, but are formulated to provide a framework on which to build clinical decisions. Pharmacologic interventions are to be initiated taking into consideration an individual patient?s risk profile.
Impression and recommendation
- Osteoporosis.
- FRAX derived 10 year fracture risk is 16.5% for major osteoporotic fracture (spine, hip, forearm, and humerus) and 5.3 % for a hip fracture.
If clinically indicated, would consider a work up to rule out secondary causes of bone loss and therapy to prevent further loss and fractures accordingly.
Now the doctor advice me to take s.c injection of denosumab (prolia) .. Do you recommend that ? Is it safe ? What's the side effects and should I really take it ?
Thanks
Batool
Below is a medical report for bone density exam done several months ago. From that time to this time I am taking boniva 150 mg once monthly
Clinical Indication
67 year old patient, from Iraq, mild scoliosis, parental history of hip fracture, on no calcium, R/O osteoporosis.
Skeletal Region Bone density (g/cm2) SD* above or below the mean for young adults SD* above or below the mean for age- matched controls
AP spine (L3-L4) 0.669 -3.9 -1.9
Femur Total 0.793 -1.2 0.1
Femur Neck 0.574 -2.5 -0.5
Forearm (Radius 33%) 0.617 -1.3 0.6
*SD: standard deviation
Findings
BMD measurements reveal the presence of osteoporosis.
Noted on the scan image is the presence of mild scoliosis, sclerosis of L1 and L2, that may falsely increase bone mass. L1 and L2 were therefore deleted from analysis. X-rays of lumbar spine would be helpful to further characterize these changes. The patient trabecular bone score (TBS) an index of bone microarchitecture and an independent predictor of fracture, from L3-L4 is 0.96. TBS normative database derived using Caucasian population.
Risk Assessment
The TBS adjusted FRAX derived 10 year fracture risk, using FRAX Lebanon as a surrogate country, is 16.5% for major osteoporotic fracture (spine, hip, forearm, and humerus) and 5.3 % for a hip fracture. The 2013 Lebanese FRAX-based osteoporosis guidelines may be accessed on the following link http://www.aub.edu.lb/FM/CMOP/Pages/LebaneseGuidelines.aspx. These guidelines do not supersede clinical judgment, but are formulated to provide a framework on which to build clinical decisions. Pharmacologic interventions are to be initiated taking into consideration an individual patient?s risk profile.
Impression and recommendation
- Osteoporosis.
- FRAX derived 10 year fracture risk is 16.5% for major osteoporotic fracture (spine, hip, forearm, and humerus) and 5.3 % for a hip fracture.
If clinically indicated, would consider a work up to rule out secondary causes of bone loss and therapy to prevent further loss and fractures accordingly.
Now the doctor advice me to take s.c injection of denosumab (prolia) .. Do you recommend that ? Is it safe ? What's the side effects and should I really take it ?
Thanks
Batool
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello Batool!
Welcome to Ask a Doctor service!
I agree with your doctor on the recommendation of taking Denosumab injection, as this drug is usually used in such cases, when other treatments like boniva have not resulted effective.
It is true that boniva has less adverse effects compared to this new drug, but you should know that its effects are quite more potent compared to boniva.
Regarding its adverse effects, its main adverse effects are:
- back pain in 30% of patients
- limb pain in 11 % of patients
-fatigue and tiredness in 45%
- low phosphorus
-nausea and indigestion in up to 30% of patients
-cough (less than 15 %)
-diarrea (20%).
Other much more rare adverse effects are: muscle pain, urinary tract infection, pneumonia, abdominal pain, insomnia, etc..
So, I would recommend trying it and see if you tolerate it well.
If you experience any of the above mentioned adverse effects , which you may not tolerate, you may switch to boniva again.
Hope to have been helpful to you!
I remain at your disposal in case of further questions whenever you need!
Kind regards,
Dr. Ilir Sharka
I would explain as follows:
Detailed Answer:
Hello Batool!
Welcome to Ask a Doctor service!
I agree with your doctor on the recommendation of taking Denosumab injection, as this drug is usually used in such cases, when other treatments like boniva have not resulted effective.
It is true that boniva has less adverse effects compared to this new drug, but you should know that its effects are quite more potent compared to boniva.
Regarding its adverse effects, its main adverse effects are:
- back pain in 30% of patients
- limb pain in 11 % of patients
-fatigue and tiredness in 45%
- low phosphorus
-nausea and indigestion in up to 30% of patients
-cough (less than 15 %)
-diarrea (20%).
Other much more rare adverse effects are: muscle pain, urinary tract infection, pneumonia, abdominal pain, insomnia, etc..
So, I would recommend trying it and see if you tolerate it well.
If you experience any of the above mentioned adverse effects , which you may not tolerate, you may switch to boniva again.
Hope to have been helpful to you!
I remain at your disposal in case of further questions whenever you need!
Kind regards,
Dr. Ilir Sharka
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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