With all the high-tech imaging available for multiple myeloma, like PET scans, MRIs, and whole-body CT, you might wonder, do I still need a DEXA scan? In this Health Tree University lesson, we break down the unique role of DEXA, bone density scans in myeloma care, especially when it comes to detecting osteoporosis and fracture risk that advanced imaging can miss. Learn how bone health monitoring with DEXA fits into a full picture of your myeloma management and what you should ask your doctor. What is a DEXA scan? Why should myeloma patients consider getting a DEXA scan in addition to the advanced imaging techniques used to monitor myeloma response and relapse? So, DEXA scan is actually an X-ray technology. It is used to measure bone density. Now, why is it not what we use for myeloma? Isn't it nice to be able to measure bone density? It has to do with it doesn't actually pick up lytic lesions. When DEXA scans reported, you'll see in your report, it's actually measuring three representative spots in the body that predict the risk of fractures in patients with osteoporosis. So, it's an entirely, it's a proven technology in a different setup. So say, it's not going to tell us very much about lesions in the skull, in the ribs, because it's measuring the spine, the neck of the femur, so at the hip, and actually the outer bone. So, representative places. In my mind, it does have added value because it's telling about bone health in general. The kind of imaging we have tells the local areas that we need to focus our attention. Now, so why do people not get DEXA scan all the time? It's probably mostly because in our myeloma patients, once they're symptomatic, we're already incorporating medication like salineic acid, which is a treatment for osteoporosis. When it's approved for osteoporosis, it's once a year. When we're using it in multiple myeloma, it's typically once a month. So we're already treating over and beyond the osteoporosis population. They don't always do DEXA scan when patients are on active treatment and continue to receive bisphosphonate. But in who might I think they should still kind of resume this general health maintenance, including the DEXA scan? It's typically probably patients who are out in remission. They're off from their salineic acid. We're still worried about their bone health. DEXA scan comes in because it'll probably give us an idea, are there still further bone decline? And we can restart some of the medications to actually help boosting bone health, even in patients who are in remission. The other group that probably will benefit from the DEXA scan is actually patients with smoldering myeloma. Because all of those whole body CT MRI that we talked about, it actually doesn't tell us about bone thickness, bone mass. And we know that patients with smoldering myeloma, in fact, have increased risk of osteoporosis. So I don't do them more than the standard of care, but I don't want to miss having a chance to detect an early bone changes in those patients and treat them properly. So I think DEXA scan in those populations important. Because of the way multiple myeloma attacks the bones, maintaining good bone health is an integral part of multiple myeloma care that we provide to patients. And at diagnosis, almost 100% of my patients get a PET scan. PET scan looks from head to toe if there's any bony lesions or lytic lesions, which are holes in the bones. And if they are present, we give patients bisphosphonates or XGVOD, depending on what they get to strengthen their bones. Now, there may be a subset of patients who actually do not have these lesions and have a normal PET scan. In those patients, it might be important to get a DEXA scan to really know whether the patient has osteopenia or osteoporosis, because we do not want the patient to end up getting a fracture, a hip fracture or a bone fracture anywhere that affects the patient's quality of life. And if that's present, then we like to give patients, again, Zomeda or XGVOD to strengthen their bones. Can a DEXA scan be done instead of advanced imaging? The scientific literature on DEXA scan is not really convincing. So 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 it's DEXA is only very limited by its information that it gives. It's a 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. 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. While MRIs, CT and PET scans are powerful tools for tracking disease, the humble DEXA scan tells us whether your bones can take the pressure. Bone health is cancer care too. If you're living with myeloma, ask your doctor if it's time for a DEXA scan. And if this video helped you, give it a thumbs up, subscribe, and share with someone who needs to hear this.
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