Bone density testing is another one of those tests that seem inevitable as we age, especially for women. You should always work to improve bone density. For myself and my office, however, I view bone density as a powerful tool giving us the ability to look into how much your lifestyle is impacting your bone health.
We have a peripheral DXA unit and run bone density testing days in office. I strongly promote the idea that everyone over the age of 25 should have his or her bone density checked. Much like everything else in medicine, we normally wait to test until we are more likely to be in the crisis stage.
For me personally, I’d prefer to know if there is a problem decades earlier and make some small changes now rather than drastic changes later.
Beyond this, however, there is a much deeper discussion that I frequently have to have with patients about bone density testing. I have had patients with very low bone density who have not had a fracture, and clearly there are those who suffer fractures despite good bone density scores.
Further complicating the issue, drugs used to treat osteoporosis like Fosamax and Actonel may raise bone density but don’t always lower the risk of fractures. But I thought bone density = fracture risk???
The relationship is not so clear. Actually, bone density alone only accounts for about 25% of your fracture risk. This means that if you have a bone density test that comes back in the osteoporotic range and your doctor merely writes a prescription for Fosomax or Actonel, he or she has done a great disservice and merely scratched one aspect of fracture risk.
Hopefully, this will soon be changing. There has been a fracture risk assessment tool developed call the FRAX tool, that is gaining ground as a much better marker of your personal risk of suffering a low impact fracture. And guess what? Bone density is only one small factor in this risk. This particular article delves into the changing dynamic as it relates to predicting your risk of fractures.
So what IS included? Here’s the list:
- country (because some countries have higher risks–ironically, closely associated with dairy intake…)
- bone mineral density
- low body mass index
- previous fragility fracture
- parental history of hip fracture
- glucocorticoid treatment
- current smoking
- alcohol intake (3 or more units per day)
- rheumatoid arthritis
- other secondary causes of osteoporosis
You can see it is a much more comprehensive list than merely checking bone density. One thing that is not on here that I would add is your overall risk of falling. A higher risk of falling will obviously increase your risk of suffering a fracture. Because of this, activities like whole body vibration, yoga, tai-chi and strength training of the legs will lower your risk of a fracture because you are going to lower your risk of a fall. Pretty simple.
None of this, however, addresses the factor of bone health in general, which I have covered in a previous blog article that can be read by clicking here.
In the meantime, this is a great opportunity to see just how fast your doctors adopt current medical research. The FRAX tool has been around for some time now, but is clearly gaining ground in its ability to predict your risk of a fracture. At this stage, the evidence is solid enough to make this tool almost a requirement in a conscientious, up to date on the research doctor’s office. If your doctor is willing to order a bone density test, but ONLY recommends medications if it comes back in the osteoporotic range without any additional questions being asked, maybe it’s time to move on.
If you have had a bone density test that came back in the osteopenic range (the range that medications should ABSOLUTELY NOT be used), did your doctor recommend medications?