Practical Prevention--Who Needs Bone Mineral Density Testing?
Betty, a 46-year-old friend of mine, recently requested a bone density test. Her sister had developed osteoporosis at about the same age. When her doctor declined, she went to a walk-in clinic to have the test. The results revealed early bone loss.
Bone mineral density (BMD) testing has become more available in the U.S., so it's easier than ever to get checked for osteoporosis. Though a BMD test may not be appropriate for everyone, for some, like Betty, it may provide an important prevention opportunity.
Primarily a Woman's Disease
Osteoporosis slowly weakens bones and puts people at risk for broken bones. As a result, about one out of two women will have a fracture due to osteoporosis during her lifetime.
The consequences can be devastating. Spinal fractures may lead to stooped posture, loss of height, chronic pain and disability, and compression of the stomach or lungs. Hip fractures are even more dangerous; annually they result in 40,000 deaths. Each year osteoporosis causes 1.5 million fractures of the spine, hip and wrist, causing pain, suffering, depression, difficulty functioning, and lower quality of life.
But, given early warning of thinning bones, we might avoid many of these problems.
Promise of Prevention
Since osteoporosis is a silent disease, most people don't realize they have it until after they break a bone. Even then, some don't make the connection. In a study of 1162 women age 55 and older who had suffered a wrist fracture, only 24% sought and received testing or treatment for osteoporosis.
With the advent of new technology, however, more people may get a jump-start on the problem. Machines that measure your bone density can help predict your future risk of fractures. And, the new tests can detect osteoporosis far earlier than in the past, while preventive measures may still help.
How Bone Density Testing Works
Most devices that measure bone mineral density rely on x-rays to take pictures of your bones. A computer then calculates the test results. The procedure generally takes less than 15 minutes to complete, and exposes you to about one-tenth of the radiation used in a standard chest x-ray.
Several types of machines are available to read bone density. The most-accurate machines (central machines) measure the density of your hip, spine, total body, or a combination of these sites. Peripheral machines, on the other hand, usually take measurements at only one location, such as your finger, wrist, kneecap, shinbone or heel.
Should You Have a BMD Test?
My advice is to talk to your doctor about your risks for osteoporosis. Most experts say that women should be evaluated individually to determine the need for BMD testing. Some premenopausal women, like Betty, with multiple factors that place them at high risk for osteoporosis (ie, menstrual irregularities, eating disorders, chronic diarrhea, or thyroid or kidney problems, long-term steroid treatments) may benefit from early testing.
Medicare and the National Osteoporosis Foundation recommend BMD tests for women who are:
- Postmenopausal and under age 65 with at least one risk factor for osteoporosis besides menopause. Risk factors include:
- Personal or family history of a fracture as an adult
- White race
- Heavy drinking
- Low body weight or calcium intake
- Sedentary lifestyle
- Poor health
- Impaired memory or eyesight
- Recurrent falls
- Early menopause
- Age 65 or older regardless of risk factors
- Currently showing evidence of "thin bones" on x-rays
- Considering or receiving treatment for osteoporosis
- Taking, or have taken, long-term hormone replacement or cortisone therapy. Ask your doctor about other medications that may help or hurt bone loss.
In BMD testing, the lower your results—or T-score—the higher your risk of developing a fracture. Fortunately, you can avoid fractures with timely osteoporosis care.
American Congress of Obstetricians and Gynecologists
National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center
The Society of Obstetricians and Gynaecologists of Canada
Women's Health Matters
Bone mineral density testing: who, when, how. Patient Care . 2001 Jan 15:62-82.
Consensus development conference statement: osteoporosis prevention, diagnosis, and therapy. National Institutes of Health. 2000 Mar 27-29:1-10.
Osteoporosis: bone mass measurement. National Osteoporosis Foundation website. Available at: http://www.nof.org/osteoporosis/bonemass.htm .
Osteoporosis: fast facts. National Osteoporosis Foundation website. Available at: http://www.nof.org/osteoporosis/stats.htm .
Physicians Guide to Prevention and Treatment of Osteoporosis (booklet). National Osteoporosis Foundation; 1998.
Postmenopausal osteoporosis: when and how to measure bone mineral density. Consultant . 2000 Apr 1:781-789.
Last reviewed November 2009 by ]]>Brian Randall, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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