A Doctor Read More Than 4,000 Bone Scans. Then She Ran the Test She Had Never Run on Herself.
For 20 years she told women their scans were stable and sent them home. Then her own number came back almost exactly what it had been 2 years earlier, and she finally ran the one blood test nobody had ever run on her. Both markers were up. This is what she found, and what she does differently now.
I have read too many DEXA scans to not tell you this
If your number has barely moved in 2 years and your doctor keeps calling it stable, there is something he is not connecting for you.
I have read more than 4,000 of these in 20 years. When a woman shows me a T-score that has hardly changed and tells me her doctor is pleased with it, I already know where she is headed 3 to 4 years before she ever breaks anything.
The bone is already coming out faster than it is going back in. It is already spending the margin she is going to need.
I am Dr. Jennifer Norton. I spent 20 years doing exactly what I was trained to do, which was prescribe calcium and bone drugs and watch the scans drop anyway.
And when my own scan came back at 56, I understood something most doctors never say out loud.
The number that looks stable and the fracture that comes out of nowhere are not 2 separate things. They are one process, showing up at 2 different speeds.
Fifteen minutes is not long enough to see it
Most appointments are 15 minutes. Pull up the scan. Compare it to the last one. The number looks close enough. Refill the prescription. Come back in a year. Go home.
Nobody ever runs the one blood test that shows what your bones are doing this month.
I have seen thousands of women told they were stable, handed another drug when the first stopped holding, and sent home believing the problem was being managed.
And I have seen what those same women look like 3 years later, because I am the one who sees them then.
Two patients I have not been able to forget
The 61-year-old. Osteoporosis at the spine. Fosamax, then Actonel, then Prolia when the first 2 stopped holding the line. Her number looked close to the same on the printout for years.
Nobody told her that once you are on Prolia you cannot simply stop, because the fractures come back worse when you do. She found that out from me, 4 years in, which is 4 years too late for it to have been a choice.
She came back with a wrist she broke catching herself on a kitchen counter. By then she was sleeping downstairs, because the stairs frightened her. Her whole world had shrunk to one floor of her house.
Her scan had been stable the entire time. The number was managed. The process was not.
The 58-year-old was told it was expected at her age and to keep taking the tablet. Her doctor watched her T-score hold in the same place for 3 scans and called it stable. She fractured a vertebra lifting a suitcase into the back of a car.
The morning I finally ran it on myself
I had been diagnosed 3 years earlier. Early, they told me. Nothing to worry about yet.
I had been gripping the rail on stairs I had climbed my whole life and telling myself I was tired. Sitting in the car a few minutes after the grocery run before I could carry anything in. Turning down a hand up off the floor because I did not want anyone pulling on my arm.
I have stayed active. I have done everything I tell my own patients to do. And the day I finally ran the full workup on myself, my scan read almost exactly what it had read 2 years before.
My bone turnover markers did not.
So I did something I had never once done on myself in 20 years. I drew the markers properly. 8 in the morning, after an overnight fast, the way the research does it.
Two of them. CTX-1 is the fragment that breaks off your bone collagen when old bone is taken apart. The other is BALP, bone specific alkaline phosphatase, which is what the building crew puts out while it lays new bone down.
Both of them were up. That is the part nobody had ever explained to me.
My number only looked stable because a scan measures where you are, not how fast you are moving. The moment I measured the rate, there was nothing reassuring left in it.
What a scan cannot show you
Your bone is not a solid thing that sits there and wears down. It is being taken apart and rebuilt your entire life, by 2 crews working against each other. One takes old bone away. One lays new bone down.
After menopause both crews speed up. That is not your bones working harder. That is the loss state itself, and it is the first thing the research says on the subject.
The demolition crew outruns the build crew. Every cycle, a little more comes out than goes back in. The scan cannot see it for a year or 2, because the change per cycle is too small to photograph.
That is why you can be stable on paper and break a wrist on a kitchen counter. That is why a suitcase can fracture a spine in a woman whose chart says she is doing fine. That is why the first real symptom most women get is the break itself.
You are not unlucky. You are not just getting older. Your bone is coming out faster than it is going back. And every year, the gap widens.
I spent most of my career calling that expected progression. It is not progression. It is a signal that stopped being sent.
First I tried everything I had spent years telling patients to try
I typed why is my dexa scan not improving into my own phone, at my own kitchen table, like any of my patients would have.
I took the calcium. I added the D3 and the K2. I added magnesium. I paid extra for the plant-sourced calcium because the woman at the counter said it was better.
Everything looked responsible. My markers barely moved.
There is a reason for that, and it is not that I bought the wrong brand. In 2017 the Journal of the American Medical Association published a review of 33 trials covering 51,145 adults. Calcium and vitamin D did not lower fracture risk.
Not because calcium is useless. Because calcium is material. Material is not an instruction.
It was never the calcium. It was the signal
Estrogen is what tells bone to rebuild. Not to slow down. To rebuild.
When it falls away at menopause, that instruction stops arriving. The demolition crew keeps its orders. The build crew stops getting theirs.
So the calcium still goes in. It just has nowhere to be sent, and a body that cannot direct it to bone will put it somewhere else.
That is the whole reason a woman can take everything on the shelf for years and watch her scan fall anyway. She was never short of material. She was short of the instruction.
And this is where I had to stop and admit something about my own profession. Every drug I had prescribed works on the demolition crew. Every one of them slows the loss. Not one of them restores the signal that tells bone to be built.
I was not treating the disease. I was slowing down the rate at which she lost.
The trial I could not get past
I am a doctor. For 20 years, if it was not a prescription, I did not take it seriously.
But I could not get past this one. Postmenopausal women with osteoporosis. Randomized, placebo controlled. Every single woman in the treatment group reversed her osteoporosis. The placebo group got worse.
Then I read the part that convinced me, because it was the part I could check on myself.
They drew the same 2 markers I had just run on myself, CTX-1 and BALP, at week 12, week 24 and week 48. Same protocol. 8 in the morning, after an overnight fast.
In the placebo group, CTX-1 climbed. Up 2.5% at week 12. Up 8.1% at week 24. Up 10.7% by week 48. That is what stable looks like on the inside.
In the treatment group it fell. Down 9.7% at week 12. Down 16.9% at week 24. Down 21.8% by week 48. And the density went up at the spine and at the hip while it happened.
Week 12. Not a year. Not 2 years waiting on another photograph.
What it actually is, and what is in the box
It is purified shilajit resin. A mineral resin that seeps out of rock, and the thing in it that matters is fulvic acid.
The one I take is called Optimum. It is 78% fulvic acid. Most of what turns up on Amazon comes back at 15 or 20%. It comes out of the Altai mountains, cold pressed, purified resin and not the cheap powder that wrecks the fulvic acid before it ever reaches you.
Before I go further I want to answer the thing I get asked more than anything else. My mother's sister had estrogen positive breast cancer, and any woman who has watched that happen wants an answer before she puts anything near the word estrogen.
They tested this on the exact kind of breast cancer cells that feed on estrogen. It triggered those cells to self destruct and left the healthy ones alone. It is not a hormone, and that is precisely why I am willing to say it out loud.
On the question every woman in my office asks second: heavy metals. Every batch is tested by an independent third party lab, and the full report is available on request. It is compliant with California Proposition 65, which is the strictest standard in the country and the one most shilajit on the market cannot meet.
It is made by a family-owned company out of Florida. 5-step purification, cGMP manufacturing, zero binders and zero fillers. The box is 60 tablets, 2 a day with a meal.
| Calcium, D3, K2 | Purified shilajit resin | |
|---|---|---|
| Supplies raw material | Yes | Yes |
| Restores the rebuild instruction | No | Yes |
| Moved bone turnover markers in a randomized trial | No | Yes |
| Lowered fracture risk across 33 trials | No | Not claimed |
| Density rose at spine and hip on trial | No | Yes |
Week 12, and what happened after
Week 1, nothing. There is nothing to feel with this disease, which is the entire problem with it, and knowing that did not stop me from opening the box on the ninth day and thinking about sending it back.
Week 12. I drew my own markers again. Same lab, same hour, same fast.
My CTX-1 was down. Not up, the way it had been every single time anybody had bothered to look. I sat in my own office and read it twice.
Week 16, the ache across my lower back had stopped. It had been there first thing every morning for 2 years and I had been writing it off as the desk.
Month 3, I went up my own stairs with my hands full and did not think about the rail. I got to the landing before I noticed what I had just done.
Month 4, the soreness in my right hip eased off somewhere in there and I could not tell you the week it went.
Month 6, I had the scan. My spine had been minus 2.8 when I was diagnosed. It came back minus 2.0. I read it 3 times.
The process was not being managed anymore. It was being answered.
What I do differently now
I started recommending it to a handful of my own patients. The ones whose scans looked stable and whose markers told the real story.
One of the first was a 64-year-old who had stopped carrying anything up her own stairs. Twelve weeks in, her CTX-1 came down for the first time in the 6 years I had been seeing her.
Another was a 59-year-old who had stopped picking up her own grandson, because a woman at her church broke a wrist doing it. Six months in, her scan moved the other way, and she called me from the parking lot.
For the first time in my career, I was not just managing the number. I was reaching the thing underneath it.
What Women Are Saying on Facebook
These are public comments women left on Facebook. Nobody was asked for them and nobody was paid for them. They are copied here exactly as they were posted, names and all.
If your scan keeps coming back the same number
Your stable scan is not reassuring you. It is failing to warn you.
The same process is behind the number that barely moves and the break that comes out of nowhere. And it runs a little further ahead every year, in bone you cannot see and nobody is measuring.
You do not have to stop your bone drug. You do not have to fire your doctor. Keep taking what you were prescribed.
What you have to do is put back the signal they were never trained to touch. That is all I am asking you to consider.
Because once you break the hip, that margin is gone. Once your world shrinks to one floor, you do not get it back easily. The stable scan is the warning you can still act on, while there is still bone to build with.
Questions I get asked most
CTX-1 and a formation marker. The trial measured BALP. Most labs here run P1NP instead, and both of them read the same side of the cycle. Ask for them drawn in the morning after an overnight fast, and drawn the same way every time.
It is most likely what this looks like when it works. BALP fell 16% to 23% in that trial while density rose at the spine and the hip. After menopause both crews are running too fast, so when the whole cycle calms down, both numbers come down together. It is also what Fosamax does, and what Prolia does, and nobody takes a woman off her prescription for it. The marker is not the answer. What happened to the density is the answer.
Before you compare 2 CTX-1 results to each other, check how they were drawn. Eating drops that number by as much as 40% or 50% within 2 hours, and it runs highest around 5 in the morning. If one draw was fasted at 8 and the other was after lunch, those 2 numbers are not comparable and nothing should be decided on them.
Yes. Nothing here asks you to stop, skip or delay anything you were prescribed. This puts back a signal your prescription does not treat.
The markers moved by week 12 in the trial, and the effect roughly doubled between week 12 and week 48. Density is slower, because density is a photograph. Expect to feel nothing at all for the first several weeks. That is normal and it is the hardest part.
Dr. Norton has spent more than 2 decades treating postmenopausal women with bone loss, and has read over 4,000 bone density scans. She was diagnosed with osteoporosis herself at 56. She writes about what those scans do and do not show, so that women can ask better questions about their own bones.
