The Facts on Bone Density Screening
Understanding Bone Health and Osteoporosis

by Joseph Melamed, MD
May 2009

Fractures in older adults are not uncommon. Nearly everyone has a friend or family member who has broken a bone due to "weak bones." While it typically is a woman over age 65, older men are also susceptible to fractures. About 80 percent of those affected by the disease are women.

More than 10 million people in the United States have osteoporosis and another 34 million are at high risk for the disease. Each year, nearly 1.5 million adults have fractures, which are a direct result from the condition, making it one of the most common diseases affecting older adults.

Osteoporosis is a chronic condition that occurs when there is a depletion of bone calcium and protein. The results are loss of bone mass, increased bone fragility and increased risk of fracture. The only way to accurately diagnose osteoporosis is with a bone mineral density (BMD) test.

Raleigh resident Lee Davis began having bone density scans in the late 1990s, based on her physician’s recommendations. Up until 2007, her scans were within the normal range. That year, her test revealed the beginning of osteoporosis — a condition called osteopenia. Since that time, the 59-year-old Davis has taken bone building medications and added 2,000 international units of vitamin D. Her latest scan in March 2009, showed marked improvement.

"I think that the vitamin D has made a difference in my test results," noted Davis. "Plus, I get plenty of weight bearing exercise, which is critical in keeping bones healthy."

Most people are diagnosed with osteoporosis after having what is called a fragility fracture. These fractures can be debilitating and may even result in death. The statistics are startling as about 25 percent of patients over age 50 who break a hip die within the year.

For most, bone loss is similar to hypertension as it is a ‘silent disease.’ Patients don’t know that they have had significant bone loss until their bones become so weak that a small bump or fall causes a fracture or a vertebra to collapse.

The good news is that there are excellent drug treatments available that can slow the process of bone loss and potentially reverse it. Most importantly, people need to undergo a bone density test to see if they need drug therapy.

Bone Density Testing — DXA is the Gold Standard
Different types of machines measure bone density, but DXA is considered the best by ISCD, the International Society of Clinical Densitometry — a multidisciplinary international society of physicians — including radiologists, obstetricians, gynecologists and endocrinologists. DXA, which stands for dual energy X-ray absorptionmetry, scans to measures the spine, hip and total body. Computer-generated images of various skeletal sites yield precise bone density measurements that are unmatched by other screening equipment. The painless, non-invasive scan, which takes a few seconds, quickly identifies if a patient is at risk for fractures. It is also used to monitor a patient’s response to bone-building drug treatment. It is considered a safe test as the radiation exposure is low — a little less than a cross-country airline flight.

When should you have a bone density scan?
The ISCD has developed screening guidelines, which include:

• Women aged 65 and older.
• Postmenopausal women under age 65 with risk factors for fracture.
• Women during the menopausal transition with clinical risk factors for fracture, such as low body weight, prior fracture, or high-risk medication use.
• Men aged 70 and older.
• Men under age 70 with clinical risk factors for fracture.
• Adults with a fragility fracture.
• Adults with a disease or condition associated with low bone mass or bone loss.
• Adults taking medications associated with low bone mass or bone loss.
• Anyone being considered for pharmacologic therapy.
• Anyone being treated, to monitor treatment effect.
• Anyone not receiving therapy for whom evidence of bone loss would lead to treatment.

Women discontinuing estrogen should be considered for bone density testing according to the indications listed above.

Osteoporosis is a prevalent disease that greatly impacts the quality of life for many older adults in the United States. In the past, there wasn’t much need for testing as nothing could be done to rebuild bone mass; however, times have changed. We have excellent drug therapies that can actually strengthen and rebuild bone density. Unfortunately, the condition is under diagnosed as we are not scanning people when it is indicated. The need for testing is going to grow as the population ages.

***

Dr. Melamed, a fellowship trained musculoskeletal radiologist and certified clinical densitometrist, is chief of DXA imaging at Wake Radiology Diagnostic Imaging.

Wake Radiology has one of the largest and most advanced DXA programs in the Southeast. The practice is the only provider in eastern North Carolina participating in a pilot program for facility certification by the ISCD. This rigorous new process will result in the highest possible level of accreditation for Wake Radiology’s DXA service. For more information, visit wakeradiology.com.

Back to Top