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When I was in high school, my parents were friends with a
couple called Bob and Marge. In old age Marge, a small, sweet-faced woman,
developed catastrophic bone loss and was forced to wear a sort of metal cage to
hold her body together. She was in constant pain and spent much of her time in
bed.
Osteoporosis is a real and serious condition that can
destroy your life if it gets out of hand. At this point, the only therapy
accepted by the medical establishment is a group of drugs called
bisphosphonates, which are not all that effective and should probably not be
used long term because of an increasing risk of side effects such as fractures
of the femur and osteonecrosis of the jaw. In order to avoid taking
bisphosphonates, I have been using a program of impact exercises for the hip
and spine, initially based on research by Dr. Larry Tucker at Brigham Young, as
described in the previous two posts.
The decision to start bisphosphonate therapy should not be
taken lightly. This is why it is so important for there be clear, consistent,
and reliable data on the patient’s actual condition, both in the present and as
time goes on. This year, as every year, after the DEXA had been completed, I
asked the technician to print me a copy of the report from the machine. (Copies
of pages from the 2019 and 2018 reports are included in this post.) I
immediately noticed that my spine, which had been shown as osteoporotic since
2015, was now back in osteopenia territory; it had improved by one whole
standard deviation within the past year.
The technician told me that this year’s report would look different from last year’s because this year the machine (modestly named the Lunar Prodigy Advance DXA System) had read L1-L4 instead of the L1-L2 it had looked at last year. I asked whether the change was an actual improvement or whether it was just a statistical artifact because the machine was looking at four vertebrae instead of two and she said it was an actual improvement. She also alerted me to the fact that the machine would now go back and change the numbers from all the spine readings of previous years so that the 2019 and 2018 reports would not match up. The hip readings for both years were about the same.
The technician told me that this year’s report would look different from last year’s because this year the machine (modestly named the Lunar Prodigy Advance DXA System) had read L1-L4 instead of the L1-L2 it had looked at last year. I asked whether the change was an actual improvement or whether it was just a statistical artifact because the machine was looking at four vertebrae instead of two and she said it was an actual improvement. She also alerted me to the fact that the machine would now go back and change the numbers from all the spine readings of previous years so that the 2019 and 2018 reports would not match up. The hip readings for both years were about the same.
Looking at page 1 of each of the two, the 2018 report said that my
spine was osteoporotic at 0.798 g/cm2 whereas the 2019 report says
that the 2018 reading was osteopenic at 0.931 g/cm2. It also revises
the WHO Classifications to show osteopenia for all past years, even though
previous reports have shown osteoporosis in the spine since 2015. The % Change
vs. Previous column shows no significant change in the past year!
How to make sense of this? It appears to me that machine is looking
at two different dimensions of spine health and bringing them together, rather
awkwardly, on page 1. This looks like poor scientific practice. What is really
serious, though, is that it conceals the improvement in my spine from anyone to
doesn’t actually look at the two reports side by side.
The radiologist probably didn’t do this. The linear structure of
electronic health records means that the 2018 report was probably buried about fifteen
screens down. Who has time to scroll through all that—and why bother when the
report appears to be giving you the information you need already? A week later a nurse
from my doctor’s office called to say that my doctor was recommending I take a
bisphosphonate. I pointed out that my spine seemed to have improved and that my
hip readings were stable. My guess is that the radiologist recommended the drug
in order to be protected from liability and my own doctor, who probably didn’t
have time to look at one report much less two, just took his or her word for
it.
I still wanted to know what had prompted the Lunar Prodigy to look
at two additional vertebrae so I emailed GE, the manufacturer. No response. I’m
reserving judgment until next year about the big improvement in my spine but I
do believe that the exercises are protecting my spine and hip bones at least as
well as bisphosphonates would and without the added risks.
