Hi there, I’m new and trying to understand what happened…I have three compound fractures and both my rheumatoid consultant and GP were convinced I had osteoporosis, I was started on the bone strengthening drug and sent for a Dexa scan. The results came back and my bone density is really good so I then had lots of other tests and everything is negative. Obviously it’s great that the tests are clear and my bones are strong but it’s almost 15 weeks since the fractures occurred (no trauma) and I still have to take tramadol if I do anything more strenuous than my knitting!!!
I just wondered if anyone else has had fractures like this that are unexplained?
This might answer your question it is AI generated but it gives a few reasons as to why your bone density appears to be good yet you have had fractures. Probably because your bone quality might not be very good.
Might be worth asking your doctors to check out some of the reasons given although it sounds as if that may have happened. Perhaps your bones are dense enough but the quality is poor.
What have your doctors suggested? 15 weeks probably isn’t really all that long when it comes to bones healing.
Why Bones Can Be Fragile Despite Good Density
Poor Bone Quality/Microarchitecture: The internal, honeycomblike structure (trabecular bone) may have lost its connectivity, even if the total mineral mass appears normal.
Bone Material Age: Bones that are highly mineralized can become brittle. If the bone turnover rate is too slow, old bone is not replaced with new, flexible tissue, leading to a higher susceptibility to cracking.
Secondary Conditions: Other health issues can cause fragile bones even if density is fine, such as:
Diabetes: Affects the collagen matrix of the bone, making it brittle.
Chronic Kidney Disease: Impairs bone health.
Osteomalacia: A defect in the bone-building process where the matrix doesn’t mineralize properly.
Bone Turnover Disorders: High bone turnover can lead to micro-damage in the bone that isn’t repaired properly.
Medication Side Effects: Long-term use of steroids (e.g., prednisone) can weaken the structure of the bone, independent of density.
Bone Turnover Suppression: While drugs like bisphosphonates increase density, they may, in rare cases, impair the repair of microdamage if used long-term. [1, 2, 3, 4, 5, 6]
What the “Good Density” Number Means
A T-score of -1.0 or higher is considered normal.
DEXA scans only account for about 60% of the variation in bone fragility, meaning 40% of fracture risks are missed because they depend on structural design rather than just density.
If a doctor finds a fracture despite a good scan, they will likely look into factors like high bone turnover, microcrack accumulation, or metabolic bone disease. [1, 2, 3]
Next Steps and Management
If you are experiencing fractures with “good” bone density, you should:
Consult a specialist: Seek out an endocrinologist or a specialist in metabolic bone diseases.
Evaluate Metabolic Markers: Blood tests for bone turnover markers can determine if you are losing or making bone too fast or too slow.
Physical Exam for Causes: Look for underlying causes, such as thyroid issues, parathyroid issues, or vitamin D deficiency.
Shocked that you were not prescribed a follow-up medication to fix the bone density improvement. Rebound osteoporosis caused by discontinuing denosumab is a well-known problem. Usually you would have been prescribed a bisphosphonate or teriparatide.
As a matter of interest, have ever taken Vitamin K2 supplements? It won’t reverse the current problem but it is a nutrient which is key to ensuring calcium goes to the bones. Going forward you may wish to consider including it in your regimen.
Australia has set RDA for K2 of 200 mcg mk-7. My capsules are 100 mcg so I take 2 daily. It is well tolerated and unlikely to interfere with blood thinners, unlike K1.
I hope you get prompt and competent care from the specialist. Best wishes.
Thanks for the info (and your honesty about it’s source!) The most helpful was that 15 weeks isn’t actually very long…helpful for getting perspective. The bone quality info is really interesting, makes more sense when that is taken into account. I drink so much milk I never thought I’d have bone issues but I forgot to mention the vitamin D my GP noticed it was low so gave me Adcal D3 but after two months it was even lower so I’m now on super high level vit D. She’s written to a bone specialist so fingers crossed the specialist will reply!
Hi there, I’ve never taken denosumab so not sure if your comment was meant for me…I’m a newbie and finding it a bit tricky to navigate the response stuff myself so this may go to the wrong person too! I don’t take vitamin K2 but GP has put me on very high dose D3..
I tend not to drink much milk at all - I have never liked it - I blame school milk it was either frozen to ice in winter or warm in summer
I now have Greek yoghurt every day and take some cheese but I tend to eat a lot of calcium containing foods - if you look at the ROS website you will find a list of calcium containing foods - I found that very helpful. There are so many things that you might never have thought of that you can add to boost your calcium intake.
I didn’t get on at all well with the calcium I was prescribed ( it upset my gut) and in the end the hospital fracture liaison nurse went over my diet and decided I was getting enough dietary calcium. However, I’m a ‘belt and braces person’ so I top it up with one capsule of Together Health seaweed based calcium every day.
I buy my own D3 and take 1000IU daily. I never felt the D3 provided in things like Ad-cal was enough for me, I also check my vitamin D3 levels with a home blood test twice a year and adjust if I need to. I take K3-Mk7 and magnesium with it plus boron and I take 70 - 100g of dried prunes (google and see the connection between prunes and osteoporosis) daily plus a handful of almonds.
If you are in the UK and want to splash out you could look at Osteoscan REMS scans - they show both bone strength and fragility - the people who carry them out are very good - I can recommend both Nick and now I see Alison - you have time to discuss your results and have a decent chat about them.
One day hopefully you will find your fractures are no longer as painful as they were, I also use Nordic walking poles which I found very helpful, they keep you upright and take the weight off your hips and knees and I was able to find a way to lean on them if I needed a rest and couldn’t find a bench to sit in. They also act like another set of legs if you are walking on wet or uneven ground.
Hahaha, I know what you mean about school milk, I was the weird one who actually enjoyed it! I’m also married to a dairy farmer and still enjoy it to this day! My GP is a belt and braces kind of person too, so I’m on 20 000iu of vitamin D but just once a week…the big question will be is my body utilising it??? I do eat quite a lot of almonds and will add in the prunes.
Hadn’t heard of osteoscan REMS scans will take a look it would be good to have someone who has time to explain things a bit. My biggest concern is that the fractures keep happening, started with two T9 and T10, then a spinal process fracture and more recently my GP suspected T3 has joined the club. I do (or did) have a pretty active lifestyle and find it tricky to slow down but these things really do put the brakes on things. Great idea about the walking poles, I’m currently using a very lovely hand carved shepherds crook but it’s very heavy!! Lightweight poles make more sense.
Call me cynical but I don’t think DEXA scans give an accurate picture of bone health. I’m the opposite having had a score of -2.7 on my spine with a trabacular adjustment to -4.6. Hips and femoral head not so bad. Having been flung from a 16.2hh horse ( that’s 5 foot 5) 2 days after getting the results, landing flat on my back and walking away with nothing more than a wet muddy backside I question it. For reference I am very petite, 5’1 and about 7 stone. Most 14 year olds I know are bigger than me! I’m 52 and have always been fit and healthy and regularly carrying around 20kg bags of horse food, have a physical job gardening and walk at least 3 miles a day. Only had the scan as I developed PMR in August last year and was put on prednisone. I did wonder if they take into consideration being a very small frame. I’m taking the AA but really do wonder if I actually need it.
That’s really interesting because I’m in a not dissimilar position having been farming and had horses all my life but almost the mirror opposite of yourself, I’m short and ‘stocky’ always weighed heavy but it was definitely muscle (as you recognise bales of hay/haulage mean gym membership isn’t needed!) I was actually riding on the day these fractures happened but not my own horse, I was schooling a youngster for someone else. I felt a twang as I asked for canter and it hurt like crazy but I just thought I’d pulled a muscle ended up in A&E who refused to do anything other than check my heart and give me a chest x-ray. Eventually my physio sent me for a spinal x-ray and it was a real shock knowing I’d got fractures.The most irritating thing was being told “I must have fallen off” if I mentioned horses….er, I think I’d have noticed and would have mentioned it…!!
My GP has taken me off the alandronic acid because she says it’s a horrible drug!!
Just feels like a long time before I’m allowed to ride again…
As others have mentioned, DEXA scans only measure bone density, not bone strength, so it isn’t unusual to have osteopenia or even normal bone density yet still fracture, while others with very poor bone density never fracture. Also, there are a number of reasons why the bone density results themselves may not be reliable, including arthritis in the scanned areas making density appear better than it actually is. Do you know what your actual t-scores are, and which tests have been done?
My T score is -0.6 which was hips and pelvis and didn’t include spine which I understand is the normal way to do it. All the bone health blood tests came back normal apart from vit D which is why I’m taking cholecalciferol at a high dose.
I’ve been screened for coeliac disease, bone marrow disease, and told its definitely not osteoporosis or osteopoenia…Just hoping someone from the metabolic bone disorder clinic has an idea.
I got my spinal fractures when I was doing nothing more than skipping. I felt something jar and I too thought it was muscular. So did my GP but sent me for an x ray to check. That revealed vertebral fractures and a follow-up DEXA scan confirmed OP. I guess a canter on a horse could count as high impact exercise as far as your spine is concerned.
Reading the conversation above, has reminded me that DEXA scans are also affected by your weight. DEXA tends to underestimate bone density for thin people, and overestimate it for large people. Smaller boned people likewise will have their bone density underestimated, while larger boned people will have it overestimated. It’s possible to get an idea of bone size by measuring your wrist. Here’s a good AI summary of all this:
How Wrist Size and DEXA Interact:
Bone Structure: Wrist size (circumference relative to height) is a standard method to determine if a person has a small, medium, or large frame.
DEXA Limitations: DEXA scans are 2D images that measure areal density (density over an area) rather than true volumetric density (density per volume).
False Reassurance: Because larger, thicker bones contain more total mineral content, they can produce higher density readings, making the bones appear stronger than they are.
Small Frame Issues: Conversely, thin-boned individuals may receive falsely low density readings (underestimation).
Factors Affecting Results:
Forearm Measurement: While hip and spine are standard, forearm DEXA is sometimes used, which is particularly vulnerable to bone-size effects.
Body Composition: DEXA accuracy can be impacted by extraosseous soft tissue (fat/muscle), with inaccuracies sometimes reaching 20–50% in certain individuals.
Overall Skeletal Health: Large bones do not automatically mean high-quality, fracture-resistant bone; DEXA only measures mineral density, not quality
Although produced by AI, I think this is a reliable summary as it seems to concur with all I’ve read on the subject previously. You can google how to work out bone size (body frame size) from wrist and height measurements, or here’s one example: Body Frame Size Calculator
Hi, I understand there is a REMS test that gives the strength of particular bones, not sure how widely this is accessible. There is some info on R.O. S. site I seem to think.
my GP noticed it was low so gave me Adcal D3 but after two months it was even lower so I’m now on super high level vit D. She’s written to a bone specialist so fingers crossed the specialist will reply!
but just once a week…the big question will be is my body utilising it??? I do eat quite a lot of almonds and will add in the prunes.
idea.