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Practical Prevention--Who Needs Bone Mineral Density Testing?
Bone mineral density (BMD) testing has become more available in the US, so it's easier than ever to get checked for osteoporosis
. Though a BMD test may not be appropriate for everyone, for some, it may provide an important prevention opportunity.
Contrary to popular belief, both men and women can develop osteoporosis, but it is far more common in women, especially after menopause
. Osteoporosis slowly weakens bones and puts people at risk for fractures. As a result, nearly half of Caucasian women and nearly one quarter of Caucasian men over 50 will have a fracture due to osteoporosis during their remaining 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. Each year, osteoporosis causes more than 2 million fractures of the spine, hip and wrist, causing pain, suffering, depression, difficulty functioning, and lower quality of life.
Promise of Prevention
Since osteoporosis is a silent disease, most people don't realize they have it until after they break a bone. However, there is a way to get an early warning about thinning bones that may allow you to take action. Machines that measure your bone density can help predict your future risk of fractures. Tests can detect osteoporosis before fractures, 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. 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. A computer then calculates the test results to determine the bone density.
Several types of machines are available to read bone density. The most-accurate machines, called 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.
BMD Testing Recommendations
Talk to your doctor about your risks for osteoporosis. Men and women should be evaluated individually to determine the need for BMD testing. People with multiple factors that place them at high risk for osteoporosis may benefit from early testing.
The National Osteoporosis Foundation recommends BMD for:
- All women aged 65 years and older
- All men aged 70 years and older
- Any adult with a fracture after the age 50 years old
Postmenopausal women under the age of 65 years old, perimenopausal women, and men aged 50-69 years with at least one of the following:
Lifestyle risk factors, such as:
- Heavy drinking
- Sedentary lifestyle
- Low body weight
- Low intake of vitamin D and/or calcium
- Excess intake of vitamin A
Inherited risk factors, such as:
- Caucasian race
- Family history of hip fractures, especially with a parent
- Genetic disorders
Personal history of:
- Recurrent falls
- Previous fracture as an adult
- Poor health, such as frailty
- Impaired memory or eyesight
- Early menopause
- Certain medical conditions, such as Crohn's disease, rheumatoid arthritis, multiple sclerosis, HIV infection, or heart failure
- Long-term use of certain medications, such as hormonal therapy, antiplatelets, glucocorticosteroids, immunosuppressants, or proton pump inhibitors
In BMD testing, the lower your results, or T-score, the higher your risk of developing a fracture. If you are unsure about your bone density status, talk to your doctor about osteoporosis screening. You may be able to avoid future fractures by getting tested.
American Congress of Obstetricians and Gynecologists http://www.acog.com
National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center http://www.nih.gov
The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org
Women's Health Matters http://www.womenshealthmatters.ca
Bone mass measurement: What the numbers mean. NIH Osteoporosis and Related Bone Diseases National Resource Center websie. Available at:
http://www.niams.nih.gov/Health%5FInfo/Bone/Bone%5FHealth/bone%5Fmass%5Fmeasure.asp. Updated January 2012. Accessed October 30, 2013.
Cosman F, de Beur SJ, LeBoff MS, et al. Clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014;25(10):2359-2381.
Having a bone density test. National Osteoporosis Foundation website. Available at: http://nof.org/articles/743. Accessed July 24, 2015.
Hellekson KL. NIH releases statement on osteoporosis prevention, diagnosis, and therapy. Am Fam Physician. 2002;66(1):161-162.
Korownyk C. McCormack J, Michael Allen G. Who should receive bone mineral density testing? Can Fam Physician. 2015;61(7):612.
Osteoporosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 15, 2015. Accessed July 24, 2015.