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Bone Density: Should You Be Tested?

Posted Aug 24 2008 1:49pm
LISA CLARK: Welcome to our webcast. I'm Lisa Clark. When it comes to osteoporosis, most women think they know the basics, but with 10 million cases of osteoporosis in the U.S. alone, there's no doubt people need to know more about this serious condition, which in many cases can be prevented. What exactly is osteoporosis, and why does it occur?

Joining me today to answer these questions is Dr. Carolyn Becker. She's the Associate Director of the Tony Stabile Osteoporosis Center at Columbia University. Welcome, and thanks for joining us.

CAROLYN BECKER, MD: Thank you. It's a pleasure to be here.

LISA CLARK: I want to start with a discussion of bone density. What is that, how is it measured, and why is it so important?

CAROLYN BECKER, MD: Lisa, we have found over the years that bone density is one of the major predictors of whether a person will have a fracture someday later in life. Bone density refers to the thickness of your bone, and the more porous the bone the more fragile it is and the more at high risk you are for a fracture. So getting a bone density measurement will give you an idea whether you are at high risk for breaking a bone without any trauma later in life.

LISA CLARK: How is a bone density test done?

CAROLYN BECKER, MD: There are many different ways of measuring bone density, but the most popular is called the DEXA -- dual energy x-ray absorptiometry. It's a simple, very low energy x-ray that penetrates the bone in the lower spine, the wrist and the hip, which are three areas where people are most likely to osteoporotic fractures. It gives a very accurate determination of the thickness of your bones in those different sites. There are other ways to measure bone density, but the DEXA is really the gold standard, and it's the basis upon which we make treatment recommendations and guide our patients.

LISA CLARK: That's the system that's been used a lot in clinical trials to determine osteoporosis predictability?

CAROLYN BECKER, MD: Absolutely. Most of the major clinical trials with new drug therapies and other interventions have used the DEXA as their way of predicting and measuring osteoporosis.

LISA CLARK: Let's say someone thinks, "I don't drink as much milk as I should. Maybe I should get a bone density scan." How do you tell which people really need to have them and which can wait?

CAROLYN BECKER, MD: We actually know a lot of definite risk factors for osteoporosis. Just by being female you're at risk for having lower bone density. Certain races -- Caucasians and Asian women -- are much more susceptible. Also, dairy product intake -- if you didn't drink milk, if you have low calcium, that's a risk factor. Smoking, lack of exercise, lack of regular menstrual periods. There are a whole host of risk factors that your doctor and yourself should know about and be able to tell whether you are one of those people at very high risk for osteoporosis.

LISA CLARK: When would most doctors take a look at an apparently normal female patient and say you should have a bone density scan?

CAROLYN BECKER, MD: I really feel that osteoporosis is a pediatric disease that we often diagnose in adulthood. I'd like to start with our children and our young teenage girls, who often are not getting enough milk in their diet, and they're smoking and they're drinking diet sodas and so on and never building the bones they need for the rest of their lives. But generally at age 50, at the time of menopause, is when most women will get a bone density to determine whether they are at risk, whether they should take hormone therapy, or whether they are really in pretty good shape and don't need to do anything other than calcium and vitamin D and exercise.

LISA CLARK: Other than the DEXA test, what other tests might your doctor recommend to determine bone density?

CAROLYN BECKER, MD: We know that plain x-rays of the bone are a very poor way of diagnosing osteoporosis because you have to have lost 30 to 50 percent of your bone density before it will show up on a plain x-ray, like a chest x-ray. There are ultrasounds of the heel that are now being used. Some people will measure actually a metacarpal, or a part of your finger. There are other tests that are very good for screening to pick out those at highest risk, but they're not as good for really determining who has the most serious osteoporosis or who really have regional osteoporosis, because they only measure one site, so we prefer the DEXA.

LISA CLARK: If you have a DEXA and it shows that you're in pretty good shape, how soon would you have that test repeated?

CAROLYN BECKER, MD: It depends on your risk factors. Let's say you're in good shape but you're going to start on steroids or glucocorticoids for asthma or some condition. You may actually need another DEXA in six to 12 months. For most people, we recommend going two to three years if they're in good shape before they get their next DEXA.

LISA CLARK: And Medicare is a consideration for a lot of women who are vulnerable to osteoporosis. How frequently can the test be performed and be paid for?

CAROLYN BECKER, MD: Medicare will actually pay for a DEXA every two years, but if you start a Medicare age patient on treatment, you can actually justify getting it sooner. In fact, in one year you can get a second DEXA to make sure the treatment you've initiated is working.

LISA CLARK: Where do you go to find about getting bone density screening? Is this something that is becoming a common practice? Sometimes you'll see mammograms that are done in a mobile truck. Is that starting to happen with bone density?

CAROLYN BECKER, MD: Yes, I think there are some mobile trucks with bone density -- not the DEXA, because that's hard to be mobile, but some of the more peripheral studies. The best resource, of course, is your doctor.

LISA CLARK: Right.

CAROLYN BECKER, MD: A second resource would be to go to the National Osteoporosis Foundation on the Web, or write to them or call them. Most people should at some point in their lives.

LISA CLARK: Stay informed.

CAROLYN BECKER, MD: Absolutely.

LISA CLARK: Dr. Carolyn Becker, thank you so much for joining us.

CAROLYN BECKER, MD: My pleasure, Lisa.

LISA CLARK: And our thanks to you for joining us on this webcast. I'm Lisa Clark.

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