Do you have osteoporosis - or are you at risk?

Because osteoporosis is difficult to detect in its early stages, it’s important to determine your risk well before you’ve lost much bone mass. Check the following list of risk factors; then, if you are concerned that your risk is above average, ask your doctor for a bone density test.

risk factors for osteoporosis

• being female
• having a small, thin frame
• advanced age
• a family history of osteoporosis
• early menopause (before age 40)
• irregular menstrual periods
• eating disorders, such as anorexia
• a low-calcium diet
• low testosterone in men
• a sedentary lifestyle
• cigarette smoking
• excessive alcohol intake
• malabsorption problems
• use of steroid-based medications (such as cortisone and prednisone), anticonvulsants (such as Dilantin), or thyroid hormone for a long period of time

do you have osteoporosis?

Not long ago, it was impossible to diagnose osteoporosis until a bone fractured. Now, with better X-ray techniques, osteoporosis can be defined in terms of bone mass. Bone density varies throughout the body, and different measurement techniques give different results, so there’s no absolute standard defining what is healthy. Instead, the World Health Organization has proposed a system based on relative values; that is, it set the average bone density for women in their thirties as the healthy “norm.” This is when bone mass is typically at its peak.

A medical evaluation for osteoporosis includes a physical exam, in which height and weight are measured and a check is made for pain or bone deformities. Tests for thyroid function and blood levels of vitamin D may be included as well. But the only way to accurately measure bone health is with a bone density test.

bone density test

According to the National Osteoporosis Foundation, a bone density test can do the following:

• detect low bone density before a fracture occurs
• predict your chances of fracturing a bone in the future
• confirm a diagnosis of osteoporosis if you have already fractured a bone
• distinguish spinal osteoporosis from other spinal abnormalities
• determine your rate of bone loss if the test is conducted at intervals of a year or more
• monitor the effects of treatment if the test is conducted at intervals of a year or more

A bone density test involves a scanner that uses a small amount of radiation to measure bone density. Most conventional X-rays can’t detect osteoporosis until the disease is well advanced — that is, when 25 to 40 percent of bone mass has already been lost.

The most exact way to measure bone density in the wrist, hip, and lower spine is with the dual energy X-ray absorptiometry (DEXA). Your bone health is figured using two numbers:

• Your Z score compares your bone mass with that of an average woman of your same age and body size. A Z score that’s considerably lower than the average can result from a coexisting disease or from a medication, such as Type 1 diabetes, malabsorption problems, calcium deficiency, or excessive thyroid medication.
• Your T score compares your bones to those of a hypothetical young person with optimum bone strength.

A low score in either area shows that bone was lost, or not enough was formed, at some point in your life. It does not indicate whether you are still losing bone mass. To determine that, you’d need to repeat the test after a period of time. In short, there are three outcomes of the test:

• You have a healthy bone mass level.
• You have a condition called osteopenia — that is, your bone density is below normal, which could lead to osteoporosis if not corrected.
• You have osteoporosis.

Very low bone mass at any place in the body is a good indicator that osteoporosis affects the entire body. However, the American Association of Clinical Endocrinologists recommends that baseline and follow-up measurements be taken at the hip. (Certain medical conditions, like degenerative arthritis, can give misleading bone measurements at the spine.) If possible, both sites should be measured, since the spine shows the quickest response to therapy.

If you are perimenopausal and you have a lot of risk factors, try to get tested before menopause, if for no other reason than to get a baseline reading. If you don’t have many risk factors, get tested at menopause, when bone loss speeds up.

How often a woman should get tested after menopause hasn’t been determined. Some experts recommend testing every four years if your bones are fine. If your bones are at risk, they suggest getting retested every year. Regular testing can help determine how quickly a person is losing bone mass and how well any treatment is working.

A DEXA test takes ten to 20 minutes and costs between $150 and $250. Not all insurance plans cover the cost, so check with your insurer. Also, as of July 1, 1998, Medicare carriers will have to cover the costs of the test for certain high-risk groups, including estrogen-deficient women at clinical risk of osteoporosis and people being monitored to assess the response of an approved osteoporosis drug therapy. Since private insurers often follow Medicare’s lead, bone density tests may become part of a standard evaluation for older women.

There are other bone density tests, including radiographic absorptiometry, which uses an X-ray of the hand to calculate bone density; peripheral dual-energy X-ray absorptiometry (or pDXA), which measures bone density in the arm; single-photon absorptiometry, which measures the arm or heel; quantitative computed tomography, which measures the spine; and dual-photon absorptiometry (DPA), which measures the spine or hip.

In addition, blood and urine tests can help determine how rapidly old bone is being removed and new bone being formed, as well as identify possible causes of bone loss. These tests measure proteins that are in the framework of bone or proteins that are necessary for bone formation. However, they don’t indicate how much bone mass a person has, and so do not provide the information needed to determine whether to take preventive steps, such as hormone replacement therapy. The tests only indicate whether a person is responding well to treatment for osteoporosis.

DRUGS USED TO TREAT OSTEOPOROSIS

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