Saleh Aldasouqi, MD, FACE, ECNU, is professor of medicine and chief of the endocrinology division at Michigan State University College of Human Medicine in East Lansing. His writing combines insights from his years of caring for patients and training physicians in the U.S. and internationally.

“From the Doctor’s Bag” is a blog about topics at the intersection of humanities and medicine — topics without a P-value or area under the curve. It takes a mostly lighthearted view of issues that affect health care providers as professionals and members of society, parents, siblings, spouses, neighbors or friends.

BLOG: Doc, you need a doctor, part 2

On a serious note, I must have had osteoporosis for a long time prior to diagnosis. Osteoporosis does not come overnight!

The traditional medical literature on osteoporosis has focused on postmenopausal women. The reasoning is that the two most common causes of osteoporosis are aging and loss of estrogen in women after menopause (roughly around the mid-late 50’s). Men can develop osteoporosis with age, but because men do not typically experience cessation of gonadal function (that is, loss of testosterone), men develop osteoporosis at a much older age than women. Receiving this diagnosis at a young age honestly frustrated me!

Let us discuss few scientific concepts related to osteoporosis. T-score is the principal concept for diagnosing osteoporosis and staging its severity. As many of the readers would recall, the bone density (DXA scan) report will also mention the Z-score. I will also discuss the concept of Z-score.

The early studies focused on osteoporosis in postmenopausal women. The DXA scan was first developed only for women. The study utilizes low dose CT scan technique which then gets analyzed to measure bone strength in a two-dimensional density, that is measured as gm/cm2, rather than the original density measurement (gm/cm3). The famous measures of bone density are the T-score and the Z-score, which denote standard deviations from the mean. The reference point was originally designated to bone density of women in their late 20’s as the T-score, while age-matched scores are labelled Z-scores. Later, the T-scores and Z-scores were further developed for males.

I will conclude this post with the experience of being a patient. That is, when the doctor becomes the patient.

The first painful experience was that my insurance declined covering powerful medications, namely teriparatide (Forteo, Lilly) or denosumab (Prolia, Amgen). So, I had to take a bisphosphonate. I took alendronate (Fosamax) for 1 year, but it did not touch my osteoporosis.

Then, the insurance covered Forteo. I was prescribed Forteo for 2 years, but it, too, did not touch my osteoporosis. This is not because it was ineffective, but because I was non-compliant with taking the daily injection. That is another painful experience of being a patient. We always criticize those patients of ours who we call “non-compliant,” but when we become patients, some of us, too become “non-compliant.”

So, the next step was to use Prolia, a biannual injection that is given at the doctor’s office. I have been on Prolia for 18 months.

The last painful experience of being a patient was the fact that my insurance would not approve a repeat DXA scan before 2 years from the prior one. My doctor and I wanted to know if my T-scores have improved on Prolia after 6-12 months of the medication. I will have to wait another 6 months for the next bone density scan. What if Prolia will be ineffective? What should I do?

I do not know.

At the end of the day, I am just a patient and I need a doctor. Just like my patient with the thyroid nodule told me: “Doc, you need a doctor!”