EmpowHer: Talk about identification. How do health care professionals identify a patient who has osteoporosis? What are the tests called, and are these tests commonly covered in most health insurance plans?
Dr. Binkley: A long time ago, one of my mentors always used to say you cannot find the fever if you do not check the temperature. I think that is very true with osteoporosis. You cannot look at someone and guess how dense her bones are, any more than you can look at a person and guess her blood pressure or get her cholesterol. If you want to know what a patient's bone density is, you need to measure it.
The gold standard test that we are currently using is a bone mineral density test or BMD. Also, there is a DXA or DEXA test (dual-energy x-ray absorptiometry) where an individual lays on an open table, and with extremely low radiation exposure x-rays, we measure the amount of bone that is present in her lower spine and in her hip. Then we utilize that value to determine whether her bone density is normal or borderline. Another term for borderline is osteopenia.
Remember my earlier analogy to blood pressure? You may have normal blood pressure, borderline pressure, or high blood pressure; similarly, you may have normal bone density, borderline bone density, or low bone density. DEXA testing is a Medicare-covered benefit, so all over age 65 should be tested. In fact, Medicare will reimburse patients for obtaining a bone density test. For post-menopausal women younger than age 65 with certain risk factors such as a family history of osteoporotic fracture or a personal history of fracture, most insurance plans will also allow that measurement to be made. There really is no need to be measuring bone density in healthy, pre-menopausal women. There is no evidence that giving additional drugs to this age group has any benefit. Drugs are not free, and every medication has potential side effects.
EmpowHer: But that does not exclude women from taking preventative steps along the road such as calcium supplement.
Dr. Binkley: Exactly right. For a healthy 30-year-old woman, I do not need to know what her bone density is to recommend that she have an excellent calcium intake and excellent vitamin D level. Also, she should partake in weight-bearing exercise and avoid exposure to known bone toxins such as tobacco and excessive alcohol.
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Neil Binkley, M.D.
Dr. Binkley earned his MD degree from the University of Wisconsin Medical School and subsequently received his training in Internal Medicine at the Marshfield Clinic. After several years in private practice, he returned to the University of Wisconsin in 1990 and completed a geriatric fellowship. He is board certified in Internal Medicine and Geriatrics. In 1994 he was instrumental in establishing the UW Osteoporosis Clinical Center and the Osteoporosis Clinical Research Program, offering treatment options unavailable in standard clinical practice. Additionally, his research efforts focus on osteoporosis diagnosis, osteoporosis in men and the role of nutrition in bone loss. Recent studies of vitamins K and A are lending valuable data on nutritional supplementation and bone health. Dr. Binkley also serves on the scientific advisory committee and physician certification course faculty for the International Society for Clinical Densitometry.