You might think that a bone fracture is a relatively minor health problem. But if you are a woman or a man over age 50, it means that you should get a bone density test if you’ve never had one before.
An often-overlooked problem: Most primary care doctors are good at reviewing their patients’ overall well-being, but bone health is frequently given short shrift. Discussing the strength of your bones—and the possible need for bone density testing—should always be part of your regular checkup.
Remember: Men get osteoporosis (thinning of the bones), too. In fact, complications following hip fracture are a leading cause of death in older women and men.
Mistakes to avoid…
MISTAKE #1: Not discussing bone density testing. Your age will help determine whether you need bone density testing. The National Osteoporosis Foundation recommends it—even in the absence of osteoporosis risk factors—for all women age 65 and older…and all men age 70 and older.
Testing is also advisable for postmenopausal women under age 65, menopausal women and men age 50 to 69 if they have risk factors. There is a long list of risk factors that includes medical conditions such as liver disease, kidney disease, thyroid problems and diabetes…the use of certain medications that can cause bone loss, such as steroids…being Caucasian or Asian…and having a family history of osteoporosis. Frequency of the testing varies—check with your doctor. Note: I also recommend a baseline test prior to menopause in women who have risk factors.
Good news: Especially for women with risk factors, bone density testing is usually covered by insurance. If your insurer does not cover it, it’s a test worth paying for (it usually costs $150 to $250).
MISTAKE #2: Seeing a technician—or radiologist—who isn’t properly credentialed. Only some states require bone density technicians to be trained in densitometry (the measurement of bone density), and no states require this training of the physicians who interpret the test results. This lack of professional training is responsible for most testing errors.
What you can do: It’s not enough to ask your technician if he/she has been trained—he may say “yes” (and believe it), even though the person who did the “teaching” was not properly trained. When scheduling your test, make sure the doctor who will be interpreting your results is a clinical densitometrist. To find a list of certified clinical densitometrists (CCDs) in your state, check The International Society for Clinical Densitometry.
MISTAKE #3: Not being positioned properly during the scan. Bone density is measured with a type of scan that uses technology known as dual-energy X-ray absorptiometry (DXA). For details on the test, see below.
It’s an excellent test—when it’s performed correctly. One of the most common errors is improper positioning when checking the bone density of the hip. During this part of the test, your technician should use a small device that fits between your feet to cause a 15- to 20-degree internal hip rotation.
In that position, the neck of the femur measures at its lowest bone density level…any other positioning could falsely inflate your score by up to 10%—an amount that can be the difference between whether or not a doctor diagnoses a troubling level of bone loss.
What you can do: Prior to your DXA, discuss the proper positioning with your doctor. When you are at the test, you can say to the technician, “My doctor really stressed to me the importance of getting the proper hip rotation.” That will alert your technician that you know about this element of the test…and encourage him to do it correctly.
If you’re not sure whether the device was used with earlier testing, ask the technician to check your previous scan so that he can make sure your hip is rotated to the same degree it was previously.
MISTAKE #4: Skipping important lab tests. Your DXA results are only one piece of your bone health puzzle. Laboratory tests are just as essential in forming a complete picture of your bone health. When it comes to diagnosing and treating osteoporosis, lab tests are mainly used to rule out potential secondary causes, such as low vitamin D levels, thyroid or parathyroid problems, or digestive disorders.
However, it’s also critical that your doctor assess your sex hormone levels, which have a direct impact on your bone health. For women, perimenopause- and menopause-induced low estrogen can cause a 1% to 3% loss of bone mass annually for five to 10 years. In men, hypogonadism (low testosterone) is a leading cause of osteoporosis.
What you can do: In addition to a complete blood count (that includes white and red blood cell counts) and a comprehensive metabolic panel (that checks kidney and liver function and electrolyte levels, etc.), ask for a vitamin D test and a thyroid stimulating hormone (TSH) test. Vitamin D increases calcium absorption by 50%, so you need adequate levels to maintain healthy bone. Untreated thyroid disease can result in bone loss.
Depending on your personal history, your doctor may also want tests to measure your calcium, phosphorus and magnesium levels…parathyroid functioning…cortisol levels…and more.
A dual-energy X-ray absorptiometry (DXA) scan is simple, painless, requires no injections and exposes you to very little radiation (a small fraction of that used for a chest X-ray). What happens: While lying on your back in your clothes, with your arms at your sides, you’ll be asked to hold your breath and not move for a few seconds while the machine passes over you. The complete test takes about 20 minutes. Important: You should avoid taking calcium supplements for 24 hours before the test—an undigested pill could lodge in an area and falsely bolster your results.
