Osteoporosis and Bone Density Scans: Who Should Be Screened

What it involves

NIAMS describes osteoporosis as a bone disease that develops when bone mineral density and bone mass decrease, or when the structure and strength of bone change, which can raise the risk of fractures. It is called a silent disease because you typically have no symptoms and may not know you have it until you break a bone, most often in the hip, the spine, or the wrist.

Who this is for

• Women past menopause and adults over 65 who have never discussed bone health
• Patients who broke a bone after a minor fall or lost height
• Patients taking medicines long term that can affect bone, such as steroids
• Patients with a parent who had osteoporosis or a hip fracture

What to expect

• Questions about fractures, height changes, diet, activity, smoking, alcohol, and family history
• A review of your medicines and conditions that can affect bone, including thyroid and digestive problems
• Blood work such as calcium or vitamin D when your provider thinks it will help
• A decision on whether you should be referred for a bone density scan, and how to read the result

Who gets osteoporosis

NIAMS says osteoporosis affects women and men of all races and ethnic groups, and that the risk rises with age. For many women it begins a year or two before menopause. It is most common in non-Hispanic white and Asian women, and African American and Hispanic women have a lower risk but are still at significant risk. NIAMS also says men are at risk, especially after age 70, and that many men wrongly think they are not.

Risk factors you cannot change and ones you can

NIAMS lists sex, age, body size, race, family history, hormone changes, diet, medicines, and lifestyle as factors, and says some cannot be changed while others, such as diet, activity, alcohol, and smoking, can. It also names conditions such as rheumatoid arthritis, gastrointestinal disease, and endocrine and hormonal diseases. The thyroid care page explains how a common hormonal condition is followed. Low vitamin D is covered in the vitamin D and B12 blood tests page.

Medicines that can affect bone

NIAMS says long-term use of certain medicines may make bone loss more likely:

• Glucocorticoids, used for conditions such as asthma and rheumatoid arthritis
• Antiepileptic medicines and hormone-based cancer treatments
• Proton pump inhibitors that lower stomach acid
• Selective serotonin reuptake inhibitors and thiazolidinediones for type 2 diabetes

What a bone density scan is

MedlinePlus says a bone density scan, also called a DEXA or DXA scan, is a low-dose x-ray that measures calcium and other minerals in your bones. It is used to diagnose low bone mass and osteoporosis, predict fracture risk, and see whether treatment is working. A central scan checks the lower spine and hip, usually in a hospital or clinic, and takes 10 to 30 minutes. It uses very low radiation but is not recommended during pregnancy. At Serenity, the scan would be arranged by referral.

Who is advised to have one, and what the numbers mean

MedlinePlus says most women age 65 or older should have a scan, and that other women and men may need one if they have very low body weight, a fracture after age 50, a loss of half an inch of height in a year, or a family history. A T-score of -1.0 or higher is considered normal, between -1.0 and -2.4 is low bone density, and -2.5 or lower probably means osteoporosis. Repeat timing is based on risk. Your annual visit, covered in the Medicare annual wellness visit guide, is a natural place to ask.

Protecting bone and spotting fractures

NIAMS recommends weight-bearing exercise such as walking, drinking alcohol in moderation, not smoking, a diet rich in calcium and vitamin D, and taking prescribed medicines. It says spine fractures can show up as severe back pain, loss of height, or a stooped posture. New back pain after a minor fall is worth a visit, and the low back pain evaluation covers the other causes. The preventive care overview describes ongoing follow-up. A hip fracture causes sudden, severe pain, and the hip pain evaluation lists it with the other causes of hip pain and the emergency signs that mean going to a hospital. A fracture of the heel bone from a hard landing in a fall is covered in the heel pain and plantar fasciitis guide, which lists the signs that mean being seen quickly.

Sources

• NIAMS — Osteoporosis
• MedlinePlus — Bone Density Scan