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Bone Density: A Clue to Your Future

DEXA bone density scans: Will you glide into your golden years or live out a fractured fairy tale?
By
WebMD Feature
Reviewed by Louise Chang, MD

Health-conscious women who wouldn't dream of skipping their Pap test or mammogram appointments can be woefully ignorant about another type of vital health check -- the bone density test.

This quick and painless evaluation, often done for the first time after menopause, can help predict whether you'll sprint through your middle years and beyond, or shuffle along painfully due to thinning bones and fractures. More importantly, the test results can help your doctor decide if medication or lifestyle changes are needed now to rescue your "thinning" bones.

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Predicting Bad Bones: Bone Density Tests

"Bone density tests turn out to be a good predictor of fracture risk," says Felicia Cosman, MD, clinical director of the National Osteoporosis Foundation in Washington, and a New York physician. Minimizing that risk is important, because the older you are, the more serious a fracture can be -- often resulting in lengthy hospitalization and long-term loss of your mobility.

And certain women are at higher risk of low bone mass, called osteoporosis, in which bones are likely to fracture. What increases your osteoporosis risk?

  • A family history of the disease
  • Having a small, thin frame
  • Certain medical conditions, such as rheumatoid arthritis
  • Taking certain medications, such as corticosteroids
  • Lifestyle factors: Alcohol use; getting little exercise; smoking; drinking cola; a diet low in calcium, phosphorus, and vitamin D.

Unfortunately, many women are unsure if -- and when -- they need a bone density test, if they're aware of the test at all.

When Should You Get That First Bone Density Scan?

Some of the confusion about the test is understandable because official recommendations and advice from physicians on when to first get tested isn't in perfect agreement.

For instance, the National Osteoporosis Foundation as well as the American Association of Clinical Endocrinologists recommends all women aged 65 and over , as well as women and men after age fifty who experience fractures, get a bone density test. They also suggest that younger women who have gone through menopause and have one or more risk factors (such as family history of spine fractures) get tested, too.

Despite those guidelines, many physicians say that all average, healthy women should get a bone density test when they enter menopause, says Laura Tosi, MD, director of the bone health program at Children's National Medical Center in Washington. That makes sense, she says, because bone loss tends to speed up in the years after menopause, so getting a baseline idea of where you stand as you enter menopause gives you something to compare later scans to.

And some women should get the test even earlier, Tosi says. For instance, a woman who is 40 or so and suffers a "fragility" fracture -- a bone break that occurs when you fall from a standing height (about 5.5 feet or less) -- should get a bone density test, Tosi says. That type of fracture, she reasons, doesn't occur to strong bones.

Women who have been on high-dose corticosteroid medications to treat autoimmune disease such as lupus, along with women who have thyroid disease, should consider a bone density test, too, Tosi says, because they are more likely than others to have lower bone density.

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