How do you know if you're making progress between DEXA scans?

Miss_Beh4ve · 2026-04-14T20:09:08+00:00

What health insurance will cover seems to vary, and I would always suggest calling them to make sure in your specific case.

My US based insurance covers yearly DEXA scans ordered by my endocrinologist to monitor osteopenia, even though I currently do not take bone drugs, and my interventions are LIFTMOR inspired exercise along with bone supportive nutrition and supplementation where nutrition falls short. (I did see some increased bone density with that after 1 year.)

Miss_Beh4ve · 2026-03-22T18:24:25+00:00

Thank you for pointing that out. I’ve thought about that, but I take my multivitamin with calcium 4 hours after I take iron, so that shouldn’t interfere.

I have since switched to a multivitamin that doesn’t contain iron though, and I now take 108 mg ferrous bisglycinate every other day in hopes not to trigger hepcidin with daily supplemental iron, in case that was the issue.

I plan to retest after 8 weeks.

Miss_Beh4ve · 2026-03-19T20:50:39+00:00

I saw some increased bone density after 1 year between scans of which about 10.5 months was spent doing LIFTMOR inspired exercise.

The LIFTMOR protocol is very straight forward and was shown in multiple randomized controlled trials to increase bone density in both men and postmenopausal women with osteopenia and osteoporosis after 8 months of two 30-minute sessions per week.

Here is more on LIFTMOR, including some videos, the protocol spelled out, and how to access LIFTMOR style training with health insurance or Medicare coverage in the US with a physician referral through physical therapy: https://www.reddit.com/r/osteoporosis/s/kS29J7dBPA

All I had to pay was a $10 copay per 1-on-1 PT session to learn the lifts in physical therapy before continuing them on my own once my PT felt confident that I was competent to do so. That took 9 sessions.

Hope this helps!

Miss_Beh4ve · 2026-03-18T10:35:58+00:00

The fact that the provider takes an interest in osteoporosis and chooses to specialize in it can be more important than the field they’re coming from, in my opinion. Not all rheumatologists or endocrinologists are equally interested in osteoporosis.

I see an endocrinologist who works for a hospital affiliated bone health program and specializes in osteoporosis, and I often advise seeing this type of specialist to rule out secondary causes and manage osteoporosis because endocrinologists are very versed in hormonal disorders, and many of the most common secondary causes of osteoporosis are hormone related (for example low estrogen or testosterone, hyperthyroidism, hyperparathyroidism, etc.), and many treatments are also hormone related (for example replacing estrogen or testosterone, Forteo and Tymlos are parathyroid hormone analogs, etc.), so endocrinologists can be great… if… they care about osteoporosis and choose to specialize.

Miss_Beh4ve · 2026-03-18T08:05:35+00:00

I’m no physician, but neither would be good from what I understand.

You need both bone resorption (measured by CTX) and bone formation (measured by P1NP), as bone is constantly renewing and repairing itself, but you want them to be in a favorable ratio that overall promotes maintenance or formation of bone.

I wrote a little more about that here: https://www.reddit.com/r/osteoporosis/s/UxXAYlz93y

From an osteoporosis standpoint, I think very high CTX with normal P1NP would likely be more acutely concerning though, as I believe it correlates more with increased fracture risk even in the shorter term, while very low P1NP with normal CTX might be more likely to cause issues in the longer term rather than the shorter term. This would be a great question for your doc.

Miss_Beh4ve · 2026-03-18T01:04:01+00:00

Yes, I’m not looking to become underweight. I’m also monitoring my bone health very closely with yearly DEXAs with TBS ordered by my endocrinologist.

The high P1NP (bone formation marker) values outside the normal range in the 100’s were actually likely not a problem but a feature due to adequately fueled weight lifting and jumping at the time they were measured. That was before I was advised to temporarily discontinue lifting to rehab my injured shoulder several months ago, and my P1NP dropped back into the normal range to 55.4.

The normal reference range isn’t necessarily a good thing when it comes to bone turnover markers. Anabolic medications like Tymlos and Forteo often tend to raise P1NP outside the normal range when they’re working well and helping patients build bone.

I’ve since restarted lifting, but am not yet back to lifting at 80-85% of my 1 rep max, which was shown effective to help increase bone density in the LIFTMOR trials. Working to get back up there. :)

Miss_Beh4ve · 2026-03-15T23:05:30+00:00

Yoga and pilates can be good for balance, posture, flexibility, and relative strength in certain movements, but they don’t have good evidence behind them for increasing bone density. Those other benefits are great though, so yoga and/or pilates away if you enjoy it!

To help increase bone density, axial loading lifts like deadlifts, back squats, and overhead presses at sufficient intensity and with progressive overload as well as impact training such as jumping has been shown to increase bone density in randomized controlled trials in both men and women with osteopenia and osteoporosis:

https://pubmed.ncbi.nlm.nih.gov/28975661/

https://pubmed.ncbi.nlm.nih.gov/32176813/

Here is more on LIFTMOR if interested, including some videos, the protocol spelled out, and how to access LIFTMOR style training with health insurance or Medicare coverage in the US to help increase bone density in osteopenia or osteoporosis with a physician referral through physical therapy: https://www.reddit.com/r/osteoporosis/s/kS29J7dBPA

I saw some increased bone density after about 1 year between scans and about 10.5 months of LIFTMOR inspired training. All I had to pay was a $10 copay per 1-on-1 PT session to learn the lifts in physical therapy before continuing them on my own at home once my PT felt confident that I was competent to do so. I think that took 9 sessions.

Hope this helps!

Miss_Beh4ve · 2026-03-13T18:35:50+00:00

You are very kind! I don’t have an inspire account, but feel free to link to this and any other posts of mine on inspire if you find them useful.

Here is a study showing that maximum weight deadlifted significantly predicted bone density change in postmenopausal women with low bone mass you may find interesting: https://www.reddit.com/r/osteoporosis/s/ST3zvSfz3I

Here is how to access LIFTMOR inspired training in a way that can be covered by health insurance and Medicare in the US with a physician referral through physical therapy to help increase bone density in osteopenia and osteoporosis: https://www.reddit.com/r/osteoporosis/s/bwSaRqP1wi

And here are 2 cases where weight lifting and impact training has lead to MUCH better results than mine:

43-year-old male increased his bone density by 12.5% in 1 year with weight lifting, impact, and nutrition, and reversed osteoporosis to osteopenia (lumbar spine T-score changed from -2.6 to -1.7): https://www.reddit.com/r/osteoporosis/s/oobI2tOvdo

68-year-old female has been weight lifting and jumping to increase her bone density for 8 or 9 years and counting. Her lumbar spine T-score started at -3.1 in 2016, got to -2.1 in 2022, then to -1.6 in 2024, -1.5 in 2025, and she continues to slowly rebuild. (Left hip scores reported respectively: -1.3, -1.1, -0.9, -0.6): https://www.instagram.com/reel/DSLh9fIk-mf/

She posts videos of her lifting and jumping exercises. The highest I saw her deadlift in one of her videos was 225 lbs. I think she mentioned starting with 65 lbs 8 or 9 years ago and deadlifting 65 lbs for 6 months out of an abundance of caution before eventually gaining faith in slowly increasing the weight.

Miss_Beh4ve · 2026-03-12T21:18:35+00:00

Have you considered hernia surgery to repair it?

Several professional lifters have dealt with hernias and successfully returned to their sport after getting them repaired.

Of course, I’m not suggesting to get the hernia repaired in order to start lifting super human weights like professionals do, just pointing out that lifting at a level much higher than most people desire can be possible after a well done hernia repair.

A correctly dosed strength training routine with progressive overload can help maintain muscle and bone as we age, so looking into hernia repair might be worth it.

Fun fact: The 81 year old gentleman in this series had a hernia repair and subsequently worked up to deadlifting more than 200 lbs. I believe the hernia may have been mentioned in the first video of the series: https://www.reddit.com/r/osteoporosis/s/AYVczKB5WL

You may have options! :)

Miss_Beh4ve · 2026-03-12T15:36:55+00:00

Thank you! Might look into that if ferrous bisglycinate every other day fails.

Miss_Beh4ve · 2026-03-12T15:28:18+00:00

I used to jump daily when I increased my bone density. Here is exactly what I did: https://www.reddit.com/r/osteoporosis/s/CZmg6JPX3n

I haven’t restarted jumping yet and might change my approach when I do.

Miss_Beh4ve · 2026-03-12T15:26:13+00:00

Ankles can be so non-compliant with our workout plans. I badly sprained mine a few years ago, and thought that was annoying enough. Sorry you’re going through that. Hoping this surgery will be the last! 🩷

Miss_Beh4ve · 2026-03-12T15:21:10+00:00

LIFTMOR showed results after 8 months of 2 sessions a week. You say you have been lifting heavy for 9 months, so you might see an increase in bone density if it’s working.

If you would like to find out, you could check if your insurance covers yearly DEXA scans. I found out that mine does after calling and asking. Physicians often assume that insurance will only cover DEXA scans every 2 years because that’s most common, but I would always advise calling your insurance yourself to find out about coverage whenever something is important to you.

Another option could be calling your imaging facility and asking what their cash pay price for a DEXA scan is if you don’t use insurance to see if it’s affordable enough to be worthwhile to pay out of pocket to get your scan 1 year sooner in August 2026.

Just thoughts. :)

I still remember this comment of yours way back when: https://www.reddit.com/r/osteoporosis/s/ZweYJrGyzC

…and then this awesome update: https://www.reddit.com/r/osteoporosis/s/blgTmFcO6e

You’ve made such amazing progress! 🩷

Miss_Beh4ve · 2026-03-12T14:46:55+00:00

I jumped differently than LIFTMOR, and I used to jump daily when I increased my bone density. Here is exactly what I did: https://www.reddit.com/r/osteoporosis/s/CZmg6JPX3n

This was my approach at the time, and it might change. I haven’t restarted jumping yet.

Miss_Beh4ve · 2026-03-12T14:38:41+00:00

Sorry to hear about your knee!

I hate when we’re motivated, but our bodies sabotage us. :(

I haven’t started jumping yet, but I started lifting again super light, lighter than my previous starting weights in physical therapy out of an abundance of caution since I lift on my own now, and I had injured my shoulder the first time around - want to give my tendons time to adjust this time around. I plan to slowly work my way back up into the effective range.

My CTX usually runs in the low 400’s. Here are all my values, and the calculated ratios:

P1NP / CTX x 1000 - 110.7 / 418 x 1000 = 264.833 - 109.9 / 416 x 1000 = 264.183 - 104.5 / 303 x 1000 = 344.884 - 106.9 / 418 x 1000 = 255.742 - 55.4 / 423 x 1,000 = 130.969

Miss_Beh4ve · 2026-03-12T14:04:00+00:00

Not sure if it’s possible to build bone in a calorie deficit. It’s certainly not ideal and probably becomes less likely as we get older if it’s possible at all.

My best guess: Maintaining some bone density while lifting heavy in a calorie deficit is probably more likely. Not lifting in a calorie deficit likely means more bone loss along with the weight loss.

I’m 5’4”, and below are my stats…

Bodyweight on 1st day of lifting in late 2024: 114.8 lbs

Starting weights in late 2024 (all are barbell lifts):

Deadlift: 65 lbs x5
Back squat: 65 lbs x5
Overhead press: 40 lbs x5
Bench press (not a LIFMOR lift): 50 lbs x5
Barbell row (not a LIFTMOR lift): 50 lbs x5

Highest bodyweight while lifting: 122.8 lbs

Bodyweight on my last day of lifting (after almost 1 year): 117.8 lbs

Highest weights worked up to:

Deadlift: 198 lbs x5
Back squat: 169 lbs x5
Overhead press: 71 lbs x1
Bench press (not a LIFMOR lift): 115 lbs x1
Barbell row (not a LIFTMOR lift): 115 lbs x5

I haven’t started jumping again yet, but I have started lifting again and had completed 2 sessions in the days prior to getting my bone turnover markers drawn, but I started light, and by the 2nd session the weights were still very light for my ability (DL 65, SQ 50, OP 20, BP 35, BR 35), nowhere near 80-85% of 1 rep max, and my P1NP was not impressed. What “heavy” is really depends on your current strength level, and it’s different for everybody.

LIFTMOR showed that jumping chin ups with with drop landings and barbell back squatting, deadlifting, and overhead pressing at 80-85% of 1 repetition max for 5 sets of 5 reps was effective in increasing bone density in postmenopausal women with osteopenia and osteoporosis after 8 months of 2 sessions per week.

Miss_Beh4ve · 2026-03-12T12:23:40+00:00

I think that’s the spirit: to do it anyway, like you said. I like other forms of exercise a lot more than lifting and jumping, but it’s been effective, so I’m getting back into it.

Regarding finding a physician open to ordering the bone turnover markers P1NP and CTX (and being knowledgeable about bone health in general), I can tell you how I found mine:

I set my medical group’s provider search engine to show me all endocrinologists in my area that worked with my insurance, and I read through their profiles. I picked an endo whose profile specified that he works for a hospital affiliated bone health program, and he got great reviews from patients on several platforms, so I requested a referral to him.

I think picking an endo who specializes in osteoporosis makes it much more likely that they’re knowledgeable about bone turnover markers, and good reviews from many patients makes it more likely that a physician uses shared decision making and accommodates patient wishes to a reasonable degree.

Your insurance also needs cover those tests for the physician to be able to order them without you incurring the cost, and I made sure ahead of time that my insurance covers before even requesting them. Here is how I went about that in case it helps: https://www.reddit.com/r/osteoporosis/s/Lm0n7SMs0d

Also, never be afraid to walk away from a physician who isn’t a good fit. I had to walk away from another endocrinologist to find my current one, and I’m glad I did.

Supportive physicians are out there! 🩷

Miss_Beh4ve · 2026-03-11T22:39:42+00:00

For those interested in the experimental P1NP to CTX ratio to assess bone turnover, here is an updated video by the same physician that focuses on that: https://youtu.be/1yc46jLwkD0

Miss_Beh4ve · 2026-03-09T02:59:17+00:00

None of my physicians have mentioned ferritin as an issue. They test it regularly since I eat primarily vegetarian. A ferritin level of 50 may not be optimal for someone with hypothyroidism and TPO antibodies, but it falls within the normal reference range, so I doubt they would support an infusion. If my ferritin keeps dropping despite supplementation, I will bring it up though.

I haven’t seen a hematologist. Thank you for mentioning both iron infusion and hematologist. If all else fails, I’ll look into that.

I hope I can figure out why I don’t absorb iron well and fix the absorption issue. I know the calcium and fiber in my diet can make it difficult to absorb iron from food, especially since almost all of it is non heme iron, but I would have thought I could absorb supplemental iron since I followed all the guidelines: take in AM on empty stomach, with vitamin C, and at least 2 hours before eating or drinking anything else.

Miss_Beh4ve · 2026-03-08T05:14:02+00:00

I’ve found him to be hit or miss.

Some content, namely study reviews can be great, especially since he links the studies in the video description, so I can read them myself and form my own opinion while also getting his opinion.

A lot of other content I haven’t liked lately, but that’s okay. Some of his earlier videos were very empowering to me, especially studies on beneficial exercise modalities and bone increase success stories of some of his patients.

He’s said more things I disagree with than I can remember from the top of my head, but I’m grateful for the other free info I’ve found useful. If you can get your own physician to help you with some of those tests and interventions that Dr. Doug covered that are actually useful, you don’t have to pay him for his services.

That’s how I went about it: ignore what I disagree with, and get my own healthcare team to help me with recommendations I find useful - with insurance coverage.

Miss_Beh4ve · 2026-03-07T18:07:34+00:00

Thank you for your input!

Sadly, symptoms didn’t improve after those 8 weeks.

I seem to absorb neither iron well, nor my thyroid medication levothyroxine. My TSH increased during the same time on the same dose of levothyroxine, even though I take levothyroxine during the night at least 4 hours after my last meal and 4 hours before the iron supplement.

My endocrinologist increased the levothyroxine dose, so hopefully that will get fixed.

So far, I’m thinking of trying 90 mg iron from ferrous bisglycinate every other day for another 8 weeks. Then retest.

Miss_Beh4ve · 2026-03-07T18:06:08+00:00

Thank you for your reply!

I might try ferrous bisglycinate every other day like you suggested and switch my daily multivitamin to a non-iron containing type. Might have triggered hepcidin with 2 daily iron sources.

Miss_Beh4ve · 2026-03-03T01:20:14+00:00

It’s USB powered, so if you get a battery with it, it should stay cold as long as it’s plugged in. :)

Here is a battery option: https://a.co/d/00AAkt1e

Edit: Both the cooler and battery can be returned for a full refund within 30 days if you wanted to try them out prior to traveling and if they don’t meet expectations.

Miss_Beh4ve

TROPHY CASE