Should I ask for a Dexa scan and/or HRT?

[redfacebigdisgrace]

I’m hoping to get a bit of advice.

I’m 51, still getting my periods no real menopause signs. I was anorexic and had no periods for about 6 months in my 20s. We have osteoporosis in our family (grandfather and aunt). I am healthy (do lots of weight bearing exercise, am at a healthy weight, don’t drink or smoke) and haven’t broken any bones. So no signs of an issue.

However, I am nervous about my bone health bearing in mind family history and my own medical history. I could afford to go privately if needed.

Any advice would be great, thanks.

I can’t see that you’d qualify for one on the NHS, so go private if you’re concerned, no point worrying yourself.

I had a dexa scan on the nhs in my early 40s for early menopause. I am glad I did as my bone density was very low. I get an NHS follow up scan every 2-5 years. If worried though you can get them privately from around £150.

Of course you should do a bone density scan and know your baseline. I think every woman should. I don't think six months of no eating 30 years ago would have any lasting consequences today.

Why would you consider HRT instead?

A strong family history used to count as a reason for NHS monitoring. I know someone who always had DEXa because of family history.

However, the report out yesterday by the Royal Osteoporosis Society highlighted the complete disaster across the UK of DEXA scans and treatment. (It was reported in the press.)

In England there is 1 scanner for 100K population, and in some areas 1 scanner for 200K population.

Waiting times are dire, women are waiting months for assessments following fractures and they are never going to catch up after the pandemic backlog.

If you pay, then pay.

I had a Dexa scan on the NHS when I was 48 due to the menopause and a very strong family history of osteoporosis.No sign of thinning bones then. Fast forward 11 years and another Dexa scan following a broken bone showed I had thinning bones. Scan was 10 months after I broke the bone.

Thanks everyone for sharing your experiences. I think I’ll try and get one privately. I’m going to take calcium supplements too.

@Payakan you asked about HRT. I’m a bit confused about whether I should be on it. At 51 I must have reduced oestrogen even though I’m not showing symptoms. I was wondering if I should take it preventatively for my bones. I was looking for advice.

Thanks everyone for sharing your experiences. I think I’ll try and get one privately. I’m going to take calcium supplements too.

@redfacebigdisgrace Please don't do this (calcium) unless your diet is low in calcium.

There is increasing concern that calcium taken as tablets can cause furring up of the arteries (like cholesterol, but different.)

Calcium supplements don't actually help much and are only for anyone who can't get enough from their diet. (You need 750mg-1000mg a day. There are plenty of food charts online showing what to eat.)

HRT- the first step is to have your DEXA scan and then think about HRT.
It can be prescribed as both treatment and prevention for osteoporosis.

@JinglingSpringbells thanks. I’m not sure about how much calcium is in my diet. I’ll need to have a look!

Vitamin D and k2 helps the absorption of calcium. So maybe take these instead of calcium tablets. Also focus on increasing weight bearing exercise, I do Caroline Girvan dumbell exercises at home.

I asked my doctor to refer me and told him I had concerns. He wasn't sure but he said he'd refer me and see what hospital said. Ten days later I had a phone call from hospital (it is very close to me) and they asked if I could be there in 20 minutes and I said yes. Apparently two people had called in at short notice to cancel appointments (less than an hour) my referral was near the top of the pile and I was close enough that they thought I could make it so they offered me the appointment rather than waste it. So off I went and I had osteopenia and due for a second scan in March five years after the first one.

I think it is worth asking, good luck.

Calcium might be an issue for those who dont eat much dairy? I’m pro plant based diets by the way - just pointing out that it’s easy to go low on some things

Hello, have you seen the Royal Osteoporosis Society website? It has lots of excellent info including a risk checker. But also, from what you've said about your family history etc I would defo look into have a private scan.

@TheFTrain thanks! Great website.

I do weight lift but I definitely need to focus on more calcium in my diet. And take vitamin D

@Iwasafool good luck with your scan.

@Iwasafool That's great but just so you know, the NHS is quite 'slow' to do re-scans at every 5 years.

Privately, I have mine every 2 years (osteopenia) and have for the last 15 years, and the advice is really every 2 to 3 years.

It takes at least 2 years to see any change (up or down) but 5 years is really pushing it if things have changed and become worse.

You have osteoporosis in your family so ask your GP to refer you for a bone density scan. I had osteopenia and HRT strengthened my bone density. I'm 75 and no longer called for 3 yearly scans but can request one which I shall do at some point as it should be monitored.

Yes, I think with your medical history and with osteoporosis in the family, it might be worth discussing having a dexa scan with your GP.

I had my first one aged 40 - premature menopause, and the doctor said it would be a good idea to have one then, to use as a benchmark for future ones. I have it done every 10 years.

I agree you're a high risk given those factors and I would definitely consider HRT alongside other options for bone protection. I had definite peri symptoms, but they were tolerable so bone protection was a major reason for deciding to take HRT.

Lots of places that do private DEXA scans will want a GP referral - I asked my GP for that and he offered to refer me on the NHS (47 with a family history of hip fracture and osteoporosis, taking HRT since 45). About 8 weeks later I had my scan and the results followed about 10 weeks later (!) showing I have slight osteopenia. GP recommended calcium and vit D but I'm tracking my dietary calcium (MyNetDiary seems quite good for this) which seems in a good range, as is my VitK, so I'm just taking vitamin D (and magnesium) - always better to get from diet if possible. Oranges are surprisingly high in calcium, and of course green veg is a good source (currently eating lots of spring greens with garlic and mustard which is delicious!).

Dr Jen Gunter has done some good articles on HRT for bone protection, e.g. https://vajenda.substack.com/p/menopausal-hormone-therapy-and-osteoporosis

Margaret Martin has some good guidance on exercise for bone health - it's a bit more complex than just doing weight bearing exercise as you need to make sure there's good coverage of all the bones and strength training really helps as well. Lots of advice on exercise for bone health seems to be targeted at people in their 70s but she has advice aimed at active people including tips on moves to avoid.

Both the NHS and the ROS have videos on their websites on bone building exercises.

The ROS used to have a list of books etc on their website but I'm not sure if it's still there.

Most of the exercises use free weights and rubber bands, targeting your hips, spine and wrists.

Not my experience re getting an appointment for rescan. My GP has reminded me to book it, I've had 3 letters from the hospital department giving me the code to log on and book my appointment but I can't actually do it until the end of the month. I can't say they are being slow at all.

My results were very marginal, some areas just registering as osteopenia and other areas were fine so the person doing the scan said 5 years was fine and recommended what to prescribe to GP and I've had my vitamin D and calcium regularly. She explained the results really well, maybe they hadn't managed to fill the other cancelled appointment so she had a bit more time to go through it all with me.

Thank you, I'm in my 70s now and definitely want to make sure all is well.

@Iwasafool I think we're talking about something different.

By 'slow' I didn't mean the actual process of booking the appointment.
I meant that the NHS only does scans every 5 years (unless women are using some treatments, when they have their scan earlier.) This isn't just a medical decision, but a financial/ resources one.

It depends on how low bone density is and someone's age.
If someone is on the edge of developing osteoporosis, they would be scanned every 2 years. And the same if they were on treatment for it.

5 years can be too long for some women because they could have slipped from osteopenia to full osteoporosis and be missing out on treatment in that time.