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Bone Density Scans and Bone Health Screenings
Bone Density Scans and Bone Health Screenings
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A bone density scan can detect thinning bones at an early stage. If you already have osteoporosis, bone scans
can also tell you how fast the disease is progressing.
But an abnormal bone scan can create as many questions as it answers. Who should get a bone density scan,
and what do the results mean? If your bone density is below normal, what can you expect, and what should
you do?
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Variations of DEXA, which measure bone density in the forearm, finger, or heel.
Quantitative computed tomography (QCT). Essentially a CAT scan of the bones, QCT provides more
detailed images than DEXA.
Ultrasound of the bones in the heel, leg, kneecap, or other areas.
While all of these can determine bone density and osteoporosis risk, "DEXA is the most important test and is
the gold standard," says Felicia Cosman, MD, clinical director for the National Osteoporosis Foundation.
The T-score is a comparison of a person's bone density with that of a healthy 30-year-old of the same sex.
The Z-score is a comparison of a person's bone density with that of an average person of the same age and
sex.
Multiplying the T-score by 10% gives a rough estimate of how much bone density has been lost.
Z-scores are not used to formally diagnose osteoporosis. Low Z-scores can sometimes be a clue to look for a
cause of osteoporosis.
First of all, unless you're a woman past menopause or a man older than 50, your risk of fracture is very low. In
these groups, even with a T-score less than -2.5, bones are usually strong and treatment isn't recommended.
On the other hand, if you've been told you have osteoporosis, take it
Recommended Related
seriously. Feeling fine is no protection at all: fractures of the spine can be to Osteoporosis
silent and painless. "Anyone with osteoporosis should be on some kind of Symptoms of a Spinal
treatment," according to Baker. Compression Fracture
probably see this coming into use in the next few years," says Rhee. compression fractures in
women over 50 are due to
Bone Scan T-Scores: When It's Time to Treat osteoporosis and treatment
can help reduce the chance of
The National Osteoporosis Foundation recommends treatment for: further compression
fractures. One or more symp...
Postmenopausal women with T-scores less than -2.0, regardless of risk Read the Symptoms of a
factors. Spinal Compression Fracture
article > >
Postmenopausal women with T-scores less than -1.5, with osteoporosis
risk factors present.
In addition, anyone with a fragility fracture (a fracture from a minor injury) should be treated for
osteoporosis. This is true regardless of the DEXA scan results.
Treatment generally begins with a bisphosphonate medicine (Actonel, Fosamax, Boniva, or Reclast). These
drugs are proven to increase bone density and reduce the risk of fracture. Other options include:
In addition, the National Osteoporosis Foundation recommends 1,200 milligrams of daily calcium intake --
through diet and/or supplements.
The general rule: anyone at risk for osteoporosis should get a bone density scan. Don’t wait for a fracture or a
formal diagnosis.
Postmenopausal women are at highest risk, because estrogen (which falls after menopause) preserves bone
strength. But men get osteoporosis, too. "They just get it later," says Mary Zoe Baker, MD, an endocrinologist
and professor of medicine at the University of Oklahoma Health Sciences Center. Usually around age 70,
"men start to catch up to women" in developing osteoporosis, according to Baker.
Women over age 65: All women over the age of 65 should get a DEXA scan, according to the National
Osteoporosis Foundation and the U.S. Preventive Services Task Force.
Postmenopausal women under age 65: For women under 65, a bone scan is not
Recommended Related
universally recommended. The National Osteoporosis Foundation to Osteoporosis
recommends a bone scan for women with risk factors for osteoporosis: Symptoms of a Spinal
Compression Fracture
History of bone fracture as an adult
It is important to identify the
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Medicare and many insurance companies will pay for a bone scan every two years in women with
osteoporosis or who are at high risk. Because the response to treatment occurs slowly, this is usually an
acceptable time interval, according to Rhee.
"In cases with high bone turnover rates, like women taking high-dose steroids," checking bone density as
often as every six months may be necessary, says Rhee.
For women with a normal bone scan, waiting a few years to retest is fine, adds Rhee.
Another thing to keep in mind: not all DEXA scanners are created equal. There are slight differences in the
calibration of different manufacturers' machines. Ideally, you should get all your bone scans on the same
DEXA scanner. Getting retested on a different manufacturer's scanner could give a false impression of bone
loss (or gain).
Kidney disease
Hyperparathyroidism (overactive secretion of parathyroid hormone)
Vitamin D deficiency
Hyperthyroidism (overactive thyroid)
Liver disease
Intestinal disease
By taking your medical history and checking routine laboratory blood tests, your doctor can detect these and
other causes for low bone density.
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Since estrogen keeps bones strong, can getting your estrogen levels checked help? "Probably not," says Baker.
Rarely, perimenopausal women with heavy periods might need hormone checks. But for the vast majority,
"DEXA is the only test they need."
SOURCES:
National Osteoporosis Foundation web site: "Fast Facts."
Khan, A. CMAJ, 2002; vol 167: pp 1141-1145.
Cranney, A. Endocrine Reviews, 2002; vol 23: pp 496-507.
U.S. Preventive Services Task Force: "Osteoporosis: Prevention and
Treatment."
National Osteoporosis Foundation web site: "Physician's Guide to
Prevention and Treatment of Osteoporosis."
Committee statement, Journal of Clinical Densitometry, 2004; vol 7: pp
17-26.
Wainwright, S. Journal of Clinical Endocrinology and Metabolism, 2005;
vol 90: pp 2787-2793.
National Osteoporosis Foundation web site: "BMD Testing: What the
Numbers Mean."
Kolta, S. Osteoporosis International, 1999; vol 10: pp 14-19.
Conference of Radiation Control Program Directors' Task Force:
"Technical White Paper: Bone Densitometry," October 2006.
Mary Rhee, MD, MS, endocrinologist and assistant professor of
medicine, Emory University, Atlanta.
Felicia Cosman, MD, clinical director, National Osteoporosis
Foundation.
Mary Zoe Baker, MD, endocrinologist and professor of medicine,
University of Oklahoma Health Sciences Center.
Reviewed on April 27, 2009
© 2007 WebMD, Inc. All rights reserved.
My Notes:
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