by Elizabeth Smoots, MD
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 (i.e., menstrual irregularities,
eating disorders, chronic diarrhea, or thyroid or kidney problems) 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
- Smoking
- 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.