Bone Health and Osteoporosis
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Testing and DiagnosisTesting is easy, painless, and risk-free, as only minor levels of radiation are used; the greatest risk is not having it done. A true diagnosis of osteoporosis can only be made after a bone density test has been done, specifically the DEXA test, as mandated by the World Health Organization. This is the "gold standard" test for bone mineral density. It is a safe test that uses very low-dose radiation-much less than a standard x-ray. It measures density at the hip, spine, and wrist. Testing is ordered by a medical doctor and is usually done by a technician; insurance covers the test every two years in women who have reached menopause and in women who have had stress or multiple fractures.
Currently, 40 percent of post-menopausal women in the United States have osteoporosis; the number might actually be greater if more women were tested.
Ask your doctor for a bone density test if you have reached menopause or have had more than three fractures over your lifetime (not due to a serious accident).
Terms and Fracture Risk Increase
- Osteoporosis = four times greater risk of fracture
- Osteopenia = two times greater risk of fracture
World Health Organization Classifications of Osteoporosis
| Term | Definition | What It Means | Recommended Tests |
|---|---|---|---|
| Osteoporosis | T score less than -2.5 | Bones are four times more likely to fracture | Bone density testing two years after medications and treatment started |
| Osteopenia | T score between -1 and -2.5 SD | Thin bones are heading toward osteoporosis | Bone at density testing least every three years |
DEXA testing is recommended at least once for all women after menopause and at all ages for women who have had more than one fracture not due to an injury. You should always have your bone density testing done at the same facility, as different machines can give different results. Standard follow-up is done one to two years after treatment begins, and every two to three years if you have osteopenia. For those with normal bone density measurements, repeat testing should be done at least once after three to four years. Other types of testing, such as heel ultrasound or wrist or finger screening, are less expensive, take less time, and have less radiation, but are much less comprehensive and do not allow for accurate evaluation of overall body bone density. These other types of testing are not recommended for women with risk factors, unless DEXA testing is not available.
Tests to Evaluate Bone Health
| Type of Test | How It Is Done | Purpose |
|---|---|---|
| DEXA | A scan is taken of your body | The gold standard for bone density; it measures density at your spine and hip and establishes a diagnosis of osteoporosis |
| PDXA | A scan is taken of your wrist, finger, or heel | Bone density at specific site tested; does not necessarily correspond to hip or spine |
| QUS (Quantitative Ultrasound) | An ultrasound scan is taken of the heel and shin | Determines bone density of the heel, whichcorresponds closely to the hip. Used as a convenient, quick screening tool |
| X-ray | A picture of your bones is taken | Evaluates fractures and other bone problems; not a screening tool for osteoporosis |
| Bone scan | Dye is injected into your blood; hours later, you have a scan taken | Evaluates a possible stress fracture or other problem with the bone; not a screening tool for osteoporosis |
| MRI, CT scan | A scan is taken (MRI more comprehensive) | Evaluates whether you have a stress fracture or other problem in your bone; not a screening tool for osteoporosis |
| Blood tests | Blood is drawn | Evaluates hormones and indicators of bone turnover helpful to understand cause |
| Urine test | Urine sampled | Measures calcium lost in urine |
| Bone biopsy | A needle is put into the | Evaluates abnormal bone |
Doctors who diagnose and treat osteoporosis can have medical degrees in various specialties; this is a reflection of the many aspects of health that thin bones can affect. For more complicated cases and when frequent stress fractures or fall fractures occur in younger girls or women, referral to an endocrinologist (hormone specialist) is recommended, as these are medical specialists who are most qualified to evaluate and treat osteoporosis. If you are in your teens or reproductive years and have had more than three fractures or absent periods, a bone density test should be done to screen for osteoporosis or osteopenia. If there is evidence of decreased bone density, it is recommended that you go to an endocrinologist to evaluate and correct the problem now to prevent future problems. For osteoporosis after menopause, your primary care doctor, gynecologist, orthopedist, physiatrist, or rheumatologist may manage your treatment.