Bone Scans and Bone Health Screenings
When should you get a bone density scan, and why?
When Should You Get a Bone Density Scan? continued...
Major expert groups make the following recommendations for osteoporosis screening and bone scans:
Women over age 65: All women over the age of 65 should get a DEXA scan, according to the National Osteoporosis Foundation and the U.S. Preventive Services Task Force.
Postmenopausal women under age 65: For women under 65, a bone scan is not universally recommended. The National Osteoporosis Foundation recommends a bone scan for women with risk factors for osteoporosis:
- History of bone fracture as an adult
- Current smoking
- History of ever taking oral steroids for more than 3 months
- Body weight under 127 pounds
- Having an immediate family member with a fragility fracture (a broken bone from a minor injury, suggesting osteoporosis).
Premenopausal women: Generally, premenopausal women should not get bone scans. Even with an abnormal DEXA scan, the risk of fracture is still very low, and treatment isn't recommended. "The No. 1 rule is, don't get the test unless you know you're going to treat" if the result is abnormal, says Baker.
Men: Experts differ in their recommendations for bone scans for men. The National Osteoporosis Foundation recommends all men over the age of 70 should get a bone scan. At that age, "many men are on their way to developing osteoporosis," says Cosman.
Bone Scans for Osteoporosis: How Often?
If you've been told you have thin bones, you'll want to know if they're improving or getting worse over time. How often should a bone scan be done?
Medicare and many insurance companies will pay for a bone scan every two years in women with osteoporosis or who are at high risk. Because the response to treatment occurs slowly, this is usually an acceptable time interval, according to Rhee.
"In cases with high bone turnover rates, like women taking high-dose steroids," checking bone density as often as every six months may be necessary, says Rhee.
For women with a normal bone scan, waiting a few years to retest is fine, adds Rhee.
Another thing to keep in mind: not all DEXA scanners are created equal. There are slight differences in the calibration of different manufacturers' machines. Ideally, you should get all your bone scans on the same DEXA scanner. Getting retested on a different manufacturer's scanner could give a false impression of bone loss (or gain).
Besides the Bone Scan: Other Tests for Osteoporosis
Are other tests needed besides a bone scan for osteoporosis? Certain medical conditions can cause thinning of the bones. These include:
- Kidney disease
- Hyperparathyroidism (overactive secretion of parathyroid hormone)
- Vitamin D deficiency
- Hyperthyroidism (overactive thyroid)
- Liver disease
- Intestinal disease
By taking your medical history and checking routine laboratory blood tests, your doctor can detect these and other causes for low bone density.
Since estrogen keeps bones strong, can getting your estrogen levels checked help? "Probably not," says Baker. Rarely, perimenopausal women with heavy periods might need hormone checks. But for the vast majority, "DEXA is the only test they need."