DEAR Dr,
My mother is 78 years old and she had a fracture on her L-1 about four months ago ,then she had surgery of vertebroplasty one month later ,two days after her surgery ,she had another fracture on her D11.
Bone densiometry report ,Whole body spect imaging report and related blood test results are as follows:
1- Bone densiometry report :
A bone mineral density (BMD)measurement was done on the mentioned patient.Dual energy X-ray Absorbtiometry (DXA technique)was used to determine the bone density of her AP spine and left hip by a Norland(EXEL)machine.Results are presented below.
Her spine BMD at L2-L4 area : 0.664g/cm2.
Compared to normal young adult Caucasians females (Norland reference )it is : 60% T- SCORE : -2.7
Compared to normal Caucasion females of the same age (Norland reference) it is : 75% Z-SCORE: - 1.3
Her hip BMD at femoral neck : 0.544g/cm2.
Compared to normal young adult Caucasians females (Norland reference ) it is : 55% T – SCORE : - 2.7
Compared to normal Caucasian females of the same age(Norland reference )it is : 82% Z – SCORE : - 1.0
INTERPRETATION:
Compared to young adult Caucasioan females and according to WHO,s criteria this study indicates very low bone density of the spine and hip.So the patient is classified as case of (OSTEOPOROSIS).
RISK FACTORS:
Caucasian.Menopause.
2-Whole Body Spect imaging( its time is before the second fracture)
Images were obtained 3 hrs. After I.V injection of 22 mci Medronate.
A notable finding is an intense uptake in the vertebral body of L1 that is better identified on 3D spect images. In addition there are multiple degenerative changes in the shoulders,knees,right shoulder and cervical spine.
IMPRESSION:
The whole body spect images in the vertebral body of L1 is infavour of active bone lesion or compression FX. X Ray correlation is recommended if clinically indicated.
3-Blood test results:
TEST RESULT REFERENCE(based
on sex/age)
PTH 19.2 pg/ml 7-82
Calcium 10.2mg/dl 8.6-10.3
Phosphorus 3.2mg/dl 2.5-4.5
Alkaline phosphatase 81 U/L 40-100
Prescribtion
Her physican has prescribed to her about 2 months ago the followings:
calsitonine nasal spray every night osteophos(alendronate sodium) 70 mg weekly calcium+vitaminD two tablet daily
Another physician has recently prescribed to her FORTEO injection instead of the above medicines.
MY QUESTIONS?
Due to the above you are kindly requested to let me know:
1- Should she inject forteo ampouls for 18 months as her treatment or take osteophos tablet weekly and calcinonine spray daily?
2- Doesn’t forteo have side –effect?
3- What is my mother’s main, real and right treatment ?
I am looking forward to hearing from you as soon as possible.
THANKS ,regards,ROYA SHOJAEI