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DESCRIPTION
Bone-Density tests are performed to measure the density of bones, usually in post-menopausal women. Bone density decreases in both men and women as they age, but in women, the decrease is more rapid and more severe once estrogen production ceases in menopausal women or after surgical removal of the ovaries. Low bone mass is a major cause of osteoporosis and of bone fractures (particularly the hip, spine or forearm) in women over age 50.
Your health care provider may be able to tell examination if it is probable that you have osteoporosis. The health care provider may notice height loss, a change in the shape of the spine, or obtain a history of fractures or back pain. X-rays are relatively not sensitive to the diagnosis of osteoporosis and since at least 20% to 30% of bone density must be lost before it is obvious on an X-ray. X-rays may be useful in documenting fractures and alteration in spinal shape.
Osteoporosis can be difficult to detect, especially since most people have no symptoms until a fracture occurs. That is why if you have risk issues, your health care provider may recommend that you have a bone density measurement.
THE VALUE OF BONE DENSITY TESTING
Bone density tests are the most reliable way to for your health care provider to diagnose osteoporosis, especially before broken bones occur. When tests are repeated over time, they can help your health care provider track your rate of bone loss or your response to treatment.
There are several types of bone density tests available. They are fast, safe, and painless; and some take only a few minutes. Testing is the best way for your health care provider to find out for sure if you have osteoporosis. If you have any question or concern at all about osteoporosis, ask your health care provider whether a bone density test is right for you. Several different methods of bone screening exist, all of which are painless, involve low-dose x-ray procedures, and range in cost from $75 to $250. Make sure you use a facility that does bone density testing on a regular basis. Most large hospitals have the necessary equipment, and some even have special osteoporosis centers.
BONE LOSS MAY BE REVERSED
If your urine test indicate you may be rapidly losing bone, your health care provider can identify various diseases that may cause this problem. A well balanced program of exercise, diet, hormone replacement as well as newer prescription medications may reverse this trend. Be sure to discuss pros and cons of any type of therapy that may be recommended.
REASONS FOR PROCEDURE
As an aid in diagnosing osteoporosis.
Family history of osteoporosis or you have other risk factors for osteoporosis.
Follow-up of a previous bone density test to determine effectiveness of any treatment.
As a predictor of fracture risks.
Low estrogen levels in a woman who has no symptoms of menopause.
After menopause, to help in making decisions about hormone replacement therapy or bone building drug therapy.
Though some medical experts recommend a bone density test for every woman after menopause, official guidelines for this type of screening test have not been established.
Women on long-term steroid therapy (corticosteriods and thyroid medications used for hypothyroidism are only a few medications that can deplete calcium in bones. Read medication side effects to see if this is a potential problem for you).
Follow-up testing for osteopenia (a term used to describe bone density that is lower than that seen in healthy young adults).
WHO SHOULD BE TESTED?
Men and women over age 50.
All women who have had hysterectomies.
Heavily exercising women of all ages.
Women with a family history of osteoporosis.
Women recently pregnant or nursing.
Women with thin, petite or small frames.
People who use anti-ulcer medication.
All people with a sedentary lifestyle.
Those who consume excessive caffeine, smokers and alcohol.
Men and women with lactose intolerance.
All people using steroid.
Women on prolonged GnRH-a therapy.
RISK
Usually no risks associated with these tests.
DESCRIPTION OF PROCEDURE
Several types of bone density tests are available. Machines called densitometers can detect a one percent bone loss. The test selected depends on available equipment, the part of the body to be tested and the costs involved.
The most accurate is the dual energy x-ray absorptionmetry (DXA or DEXA). This test uses very little radiation. You sit or lie comfortably during the 5 to 15 minute procedure. No needles or injections are used. It can measure the bone density of the spine, hip total body and wrist.
Dual proton absorptiometry (DPA) measures the spine, hip and total body. It takes about 20 to 40 minutes.
Single proton absorptiometry (SPA) measures the wrist or heel. It takes about 10 to 20 minutes.
Quantitative computed tomography (QCT) measures the spine. It takes about 10 to 15 minutes. The peripheral QCT measures the wrist.
Radiographic absorptiometry (RA) measures the hand. It takes about 3 to 5 minutes.
Additional bone density tests are being developed and may be recommended.
EXPECTED OUTCOME
Tests are completed without any complications. The test results will be reported to you in 2 numbers -- age matched and young-normal (called the T-score). The first compares your results to other women of the same age as you; the second number (T-score) compares your results to a healthy 30-year-old female (the norm). Results indicate if your bones are more dense (+), or less dense (-), or the same density as the healthy 30-year-old female (this is when peak bone density is achieved and which should be maintained for life). General ranges for interpreting bone mass T-scores are:
- Optimal = above +1.0 SD (standard deviation).
- Borderline = between a +1.0 SD and a -1.0 SD.
- Low = between a -1.0 SD and a -2.5 SD.
- Osteoporosis = below a -2.5 SD.
Note: The norm 0.0 is the healthy 30-year-old.
POSSIBLE COMPLICATIONS
None expected from the testing. However, obese women may not be able to be tested with some methods of bone-density testing due to their size. Discuss potential problems with the clinic where you are having your bone-density test taken.
POST PROCEDURE CARE
GENERAL MEASURES
No specific measures necessary following the testing.
MEDICATION
One or more medications or supplements may be prescribed depending upon the test results. These include hormone replacement therapy, bone-building drugs, vitamin D and calcium.
ACTIVITY
No restrictions immediately before or after testing. Exercise is important in developing and maintaining bone density. Follow a regular fitness program that includes aerobic activity (such as brisk walking) and weight-bearing exercises.
DIET
No special diet required prior to testing. After testing, you may need to be placed on a calcium-enriched diet for osteoporosis. See links below:
MoonDragon's Nutrition Information: Osteoporosis Diet
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You or a family member has any questions about bone density tests, their results or recommended follow-up.
Consult with a nutritionist specializing in osteoporosis, if needed.
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