Why should myeloma patients have a dexa scan in addition to advanced imaging?

Why should myeloma patients have a DEXA scan in addition to advanced imaging? Those techniques that I mentioned will help you to detect lytic lesions, but what is also important is to see whether you have bone loss, general bone loss. And that's why it's important that all patients have in addition to a PET CT or a CT scan or a skeletal survey, also a DEXA scan. The DEXA scan can be repeated yearly or every two years. It depends really how severe was your bone loss initially. But again, I usually recommend to combine a DEXA scan and an x-ray slash CT scan for imaging of your bones. The scientific literature on DEXA scan is not really convincing. The problem with the DEXA scan is you do it usually on the lumbar spine and femur, because those are very relevant if a patient, an elderly patient, it's coming from the osteoporosis field and elderly patients, if they have a fall, those are the areas they get fractures in the lumbar spine and in the femur. So it makes sense to measure the bone density there. But as you know, myeloma can grow in focal areas, so it might be outside of the lumbar spine and the femur. So DEXA is only very limited by its information that it gives. It's quantitative information on the bone density, but not really on the myeloma, because if a nostril lytic lesion is outside of the area that is scanned, you have no information that you get from a CT. You get more, you get the whole body, because we do usually whole body CTs, and we get much more information on where something is happening. So you don't get the quantitative information, you cannot say, okay, this is, they have T and Z values where you see, compared to normal bone density, where is my bone density? But this is not that helpful in myeloma, because it just might be in another area, and the CT is much more helpful. After long treatment, when you get a lot of steroids, as unfortunately myeloma patients get, then it becomes relevant, because steroids unfortunately have a long-term side effect of osteoporosis as well. That's why we only give it on short, like once a week, for example, so it's not that much of an influence, but in the long term sometimes it really makes sense to do even a DEXA scan, not for the myeloma, but for the side effects of our treatment.