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  • Practical Prevention--Who Needs Bone Mineral Density Testing?

    osteoporosis bone Bone mineral density (BMD) testing has become more available in the U.S., so it's easier than ever to get checked for osteoporosis. Though a BMD test may not be appropriate for everyone, for some, it may provide an important prevention opportunity.

    Primarily a Woman's Disease

    Osteoporosis slowly weakens bones and puts people at risk for broken bones. As a result, about one out of two women and one out of four men over 50 will have a fracture due to osteoporosis during their remaining lifetime.
    The consequences can be devastating. Spinal fractures may lead to stooped posture, loss of height, chronic pain and disability, and compression of the stomach or lungs. Hip fractures are even more dangerous. Each year, osteoporosis causes more than 2 million fractures of the spine, hip and wrist, causing pain, suffering, depression, difficulty functioning, and lower quality of life.
    But, given early warning of thinning bones, we might avoid many of these problems.

    Promise of Prevention

    Since osteoporosis is a silent disease, most people don't realize they have it until after they break a bone. However, more people may get a jump-start on the problem. Machines that measure your bone density can help predict your future risk of fractures. Tests can detect osteoporosis before fractures, while preventive measures may still help.

    How Bone Density Testing Works

    Most devices that measure bone mineral density rely on x-rays to take pictures of your bones. A computer then calculates the test results. The procedure generally takes less than 15 minutes to complete, and exposes you to about one-tenth of the radiation used in a standard chest x-ray.
    Several types of machines are available to read bone density. The most-accurate machines (central machines) measure the density of your hip, spine, total body, or a combination of these sites. Peripheral machines, on the other hand, usually take measurements at only one location, such as your finger, wrist, kneecap, shinbone or heel.

    Should You Have a BMD Test?

    Talk to your doctor about your risks for osteoporosis. Most experts say that women should be evaluated individually to determine the need for BMD testing. Some premenopausal women, with multiple factors that place them at high risk for osteoporosis may benefit from early testing.
    Medicare and the National Osteoporosis Foundation recommend BMD tests for the following women:
      Postmenopausal and under age 65 with at least one risk factor for osteoporosis besides menopause. Risk factors include:
      • Personal or family history of a fracture as an adult
      • White race
      • Smoking
      • Heavy drinking
      • Low body weight or calcium intake
      • Sedentary lifestyle
      • Poor health
      • Impaired memory or eyesight
      • Recurrent falls
      • Early menopause
    • Age 65 or older regardless of risk factors
    • Experiencing menopause and have risk factors
    • Had a fracture after age 50 years
    • Have a condition such as rheumatoid arthritis that is associated with bone loss
    • Currently showing evidence of "thin bones" on x-rays
    • Considering or receiving treatment for osteoporosis
    • Taking, or have taken, long-term hormone replacement or cortisone therapy. Ask your doctor about other medications that may help or hurt bone loss.
    In BMD testing, the lower your results—or T-score—the higher your risk of developing a fracture. Fortunately, you can avoid fractures with timely osteoporosis care.

    RESOURCES

    American Congress of Obstetricians and Gynecologists http://www.acog.com

    National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center http://www.osteo.org .

    CANADIAN RESOURCES

    The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org/index%5Fe.asp

    Women's Health Matters http://www.womenshealthmatters.ca/

    References

    Bone mineral density testing: who, when, how. Patient Care . 2001 Jan 15:62-82.

    Consensus development conference statement: osteoporosis prevention, diagnosis, and therapy. National Institutes of Health. 2000 Mar 27-29:1-10.

    Osteoporosis: bone mass measurement. National Osteoporosis Foundation website. Available at: http://www.nof.org/osteoporosis/bonemass.htm .

    Osteoporosis. EBSCO DynaMed website. Available at: http://www.ebsochost.com/dynamed. Updated November 10, 2011. Accessed November 17, 2011.

    Osteoporosis: fast facts. National Osteoporosis Foundation website. Available at: http://www.nof.org/node/40. Accessed November 17, 2011.

    Physicians Guide to Prevention and Treatment of Osteoporosis (booklet). National Osteoporosis Foundation; 1998.

    Postmenopausal osteoporosis: when and how to measure bone mineral density. Consultant . 2000 Apr 1:781-789.

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