DEXA scan results (and why you need to get one rather than rely on serum calcium level)

My surgeon never mentioned getting a DEXA scan post-op, so I did not have one until 2 years ago (at 4 years post-op).  It was fine. I had another scan yesterday (now 6 years post-op, age 51, and in menopause).  The scan shows some degeneration in my left hip (but my right hip and back still look fine).  Ugh.  At least that may explain the popping I get in my hip when I do one of my knee physical therapy exercises and tilt my hip certain ways.  I have been taking 1600 mg of calcium citrate per day and I get a fair amount of my protein from dairy products (cheese, Greek yogurt, and milk).  I know we don't absorb some of the calcium we eat, but I figured at least I would be getting some of it.

My serum calcium levels on my yearly labs have been just fine, though... always above the middle of the reference range.  So that means I am not getting enough calcium but my body is doing its job to pull the calcium it needs for my daily functioning from my bones.

This situation is exactly why everyone who has a RNY should NOT rely on their serum (blood) calcium levels to tell them whether or not they are getting enough calcium.  All the serum calcium level tells you is that your body has a calcium level that is sufficient for meeting the needs of your organs for its daily functioning.  It does NOT tell you that you are taking in enough calcium!  Surprisingly (to me, at least), my PCP did not know this until we discussed it when I asked for the order for the repeat bone scan.

So, if your surgeon did NOT tell you to get a baseline DEXA scan (it is easy and painless -- you just lay on a table for 5-10 minutes -- and is relatively inexpensive as far as scans go), get one ASAP.  It is important to know what your bones look like NOW so that if there is a change in a year or two you will know that you aren't getting enough calcium.

Now I have to figure out how to fit in a 4th calcium dose every day.   

 

Lora

In their updated 2013 guidelines, the ASMBS now recommends a bone density scan pre op and then at two years post op.  Many surgeons don't recommend them to patients, though.  I had to ask my surgeon to order one even though she said it was not necessary.

If your insurance won't cover it, or you don't have insurance, they are not that expensive.  About $400, give or take a bit, depending on where you get it done (call around and ask if they will give a discounted rate if you pay up front in cash).

We absorb very little calcium from our food because we have so little stomach acid after RNY.  Also, if your vitamin D level is below 80, the Linus Pauling Institute of Oregon State University says you won't absorb calcium well.  Doesn't mean you won't absorb any of it, but you won't absorb all of it.  Most post ops need at least 10,000 IU D3 a day to maintain a vitamin D level of at least 80.

Lora, you eat about six times a day, right?  Just take a dose of calcium with each of your meals/snacks, until you've gotten the four doses in.

The last time I had my scan done it was also right around $400.

Yeah, I eat 6 times a day and then have milk or some yogurt before bed.  I'm already taking vitamins or prescription with all but one of those, though.  So I guess I will have to add the calcium after dinner but before bed.  My Vit D level is well over, so I think in my case it is just a matter of requiring more calcium. 

I suspect that the menopause has something to do with it in my case, but everyone should be getting these, of course.  Glad to hear that the ASMBS added it to their recommendations.  Some surgeons have no clue what their recommendations are, but it should help some surgeons add DEXA scans to their protocol. People frequently post here about their labs and mention that their calcium levels are "fine" based on their lab work and I always wonder if they know the limitation of what that tells them. 

Lora

I'm sure many people don't know that the calcium level in their blood doesn't tell you much about the state of your bones or your calcium intake.  After all, your PCP wasn't even aware of that.

Excellent post  I lost 17% of my bone mass the first  year and now facing over 40% loss in my hip area.  We are trying the Forteo shots but if we had not had a base line Dexa scan I would not have known of an issue until I broke my hip

Just to give the other side,  I had my first Dexa Scan last year (insurance pays for one every other year from the age of 50) and got better than average/average results (according to my age) ...   No problems in any area.

I have not always been diligent with my calcium supplementation in the last 9 years, but do supplement at this point because I am menopausal ...

 

 

Yeah, I'm sure that lots of people (especially the younger folks) won't have any issues (at least not until they get to join the menopause club) as long as they are being reasonably diligent about calcium, but they do need to have a baseline scan done so they know what their bones look like now and will be able to identify any changes down the road.

Glad yours looks good.  I had trouble remembering my third dose of calcium for a while, but that was before my previous scan!

 

Lora

They need to know their Vitamin D and PTH numbers too. Calcium labs really tell very little in how your bones are holding up. Someone with low vitamin D and high PTH needs to make some changes to reverse those numbers.

Remember low D - high PTH = calcium leached from bones.

I had Osteopenia diagnosed through a DEXA scan prior to RNY.  Two years after RNY, and another DEXA scan, I now have Osteoporosis. My Bariatric surgeon did not discourage me from having RNY surgery. I am diligent in my Vitamin, Mineral and Calcium Citrate supplementation and I was even before RNY. I am doing a 2 year regimen of Forteo by injection. Forteo is the only medication currently on the market that builds bone. I have had no adverse side effects from this medication. I am 58 years old currently and went through Menopause at 51 years old. I also have Rheumatoid Arthritis, Osteoarthritis and Hypothyroidism. I still am happy I had RNY and even if the Sleeve was available when I had RNY in March 2010, I would have still chosen to have RNY.

I have had a scan every other year for years  my gyne orders it along with the mamo!  isnt it great this stuff!!!  I had total hysterectomy almost 20 years ago, i also have struggled to get in the last dose of calcium, workin on it!!