Bone density scans—
the test women don't think about
by Edward Strauss, M.D.
Editor's Note:
Osteoporosis is recognized as one of the most insidious degenerative diseases
plaguing the U.S. and other Westernized countries. The following article by radiologist
Edward Strauss, M.D., with comments by Ken Faulkner, Ph.D. and Susan Brown, Ph.D.,
director of The Osteoporosis Education Project, informs us of how an advanced form of
bone screening called DEXA and rethinking osteoporosis can significantly reduce the impact
of this devastating disease on our society.
Most women know they need to be screened for
breast cancer but how many think about
being tested for something that is much
more likely to affect them, osteoporosis?
Women have a lifetime risk of 40 percent of
getting osteoporosis. That's equal to the combined risk of breast cancer,
uterine cancer and ovarian cancer. Yet they don't routinely get themselves
screened for the early signs of this disease. The need for regular mammograms
is something most women understand and that's good, but they
don't think about bone density scans. Regular screenings for osteoporosis
can allow a woman to protect herself from a disease that could cripple and
even kill her. It would be tragic to have something so easily treatable go
undetected.
Women have been conditioned to think that osteoporosis is an
inevitable part of aging. You get old, you get shorter. That's just the way
it is, many women reason. Not so. There are steps that can be taken to
prevent the disease. Or if that's not possible, there are new treatments to
halt bone loss and even rebuild bone mass. With early detection and
intervention, many women can avoid this crippling and life-threatening
disease.
Osteoporosis is a silent, progressive disease characterized by
decreased bone density and increased bone fragility. It affects 15 to 20
million people in the U.S. at any given time and is responsible for $13 billion
in healthcare costs. Fractures of the hip and spine have the most
dramatic effect on people's lives. One-quarter of the deaths experienced
by elderly people are a direct or indirect result of hip fractures. Half of
the older adults who survive hip fractures will not be able to walk without
assistance and 25 percent of these survivors will require nursing
home care. Spinal fractures result in constant pain, deformity and loss
of height, a stooped posture and disability.
What many women don't know is that osteoporosis is treatable and
the earlier it's caught, the better. New advances in bone density scanning
have allowed us to identify women who are at risk decades before any
signs of the disease appear. A bone density scan isn't one of those tests
that just alerts you to the presence of the disease so you can worry about
it. It gives you the information to do something about it before it has
any effect on your life. But first you have to detect it.
At Norwalk Radiology and Digital Mammography Center we prefer
to use an advanced form of bone density screening called DEXA to
detect precursors to the disease. We find that DEXA is the most accurate
and reproducible of the bone density measurement tests. This means we
can pinpoint the need for treatment and gauge the response to that treatment
precisely. We also like the fact that it produces these results with
extremely low doses of radiation—less than 1/100th of a chest x-ray.
DEXA stands for Duel Energy X-ray Absorptiometry. It uses an x-ray
beam of two different energies that enables doctors to measure bone
strength without being confused by other tissue, like muscle, fat and
skin. This is especially important because it allows doctors to measure
bone density in the two most important areas: hips and spine. These
areas used to be almost impossible to measure because they are deep in
the body surrounded by tissue. But it is critical to find out about bone
density in these two areas because that's where the most disabling fractures
occur. DEXA also allows doctors to compare a woman's results to
those of women similar to them. This technology lets us see how a
woman compares to others of the same age, race, weight and height and
gives us the ability to extrapolate her results into the future. For example,
suppose we scan a 35-year-old premenopausal woman. Her bones
are not so bad, maybe a bit below average if you measure her against the
general population. But relative to other 35-year-olds who are at her
height, weight and race, she's lower than she should be. She doesn't have
a problem now but she could be headed for real trouble in 20 years.
We'll want to look at things like her family history and lifestyle. We will
also look into the medications she's taking that lower bone density and
see about any hormonal imbalances. After that we can decide whether
there should be changes in her lifestyle, diet, exercise or her use of supplements.
We may even look into the possibility of medication to build
bone mass today in advance of menopause. Women in menopause
suffer an accelerated loss of bone mass.
The following groups should be concerned about a bone density
screening:
- All women within a few years of menopause, particularly if it could have an impact on their decision to take hormones or not.
- People with risk factors such as a positive family history. If you've got a mother or grandmother who had problems with fractures or what is called a dowager's hump, you are at particular risk for osteoporosis.
- Women who had early menopause (in their 30s) due to the removal of ovaries or other reasons.
- People on medications. Certain medications such as steroids, blood thinners or treatments for thyroid problems may decrease bone mass.
- People with a known history of fractures or bone injuries that are not caused by massive trauma. If you are someone who gets stress fractures from something as simple as jogging, that could be a warning sign.
- Postmenopausal women.
The bottom line is that osteoporosis is not inevitable. It is detectable and
treatable. Often what needs to be done are things that should be part of
any healthy lifestyle like eating a varied diet, taking in enough calcium
and participating in a regular exercise program. All women need to be
aware of their risk of osteoporosis and protecting themselves against it. It's
an important part of taking control of your own health.
Dr. Edward Strauss is a board-certified radiologist who specializes in
analytical studies. An expert in the field, he has served as an examiner for
the American Board of Radiology and has been named for several consecutive
years as one of the country's “Top Doctors.” Norwalk Radiology is a
full-service diagnostic imaging center staffed by fellowship trained radiologists.
For more information on detecting and treating osteoporosis visit
www.norwalkradiology.com
An interview with Dr. Ken Faulkner, chief scientist, GE Lunar Densitometers, manufacturer of the DEXA device.
An interview with Dr. Ken Faulkner, chief scientist, GE Lunar
Densitometers, manufacturer of the DEXA device.
TH:Dr. Faulkner, please give us a brief overview of the DEXA devices and
how they compare to other forms of x-ray exposure.
KF: DEXA devices were introduced in 1987. This was the first time we
had x-ray beam devices to measure bone density at the spine and hip.
However, due to the fact that there were not many effective treatments for
osteoporosis, the devices weren't used much at the time.
The field began to change in 1995 when effective treatments for
strengthening bones and treating osteoporosis began to enter the market.
DEXA measurements use a fraction of a dose of conventional x-rays.
X-rays are used but it is not the image, it is the bone density measurement.
Because we don't have to get nice images, the amount of x-rays we use is
extremely small—about a tenth or even a hundredth of a mammogram or
chest x-ray. This is equivalent to a transcontinental airplane flight—even
actually less than that. Very, very low decimal radiation.
TH: How many bone densitometers are currently in use?
KF: I think in the U.S. there are about 6,000. Globally there are about 12,000.
TH: Do you have any idea how many individuals are benefiting from this
technology every year?
KF: Many are not benefiting, I am sorry to say. Recently a paper in the
Journal of the American Medical Association (JAMA) indicated half the
women over the age of 50 potentially have low bone density but are not
being measured. There is also data from the drug companies indicating
that 77 percent of women who have osteoporosis are currently not being
evaluated or treated. This is not surprising since it is a relatively young
technology—it takes a while to catch on.
TH: Are there guidelines on when women should begin to have bone density
tests?
KF: According to the National Osteoporosis Foundation, they recommend
that all women over 65 have a bone density test. Also, all postmenopausal
women, even if they are under 65, should have the test if they
have one risk factor for osteoporosis besides menopause. Things like if they
have had a facture, if relatives have had a fracture, or risk factors like smoking,
drinking or low calcium intake and low exercise, those are big risk factors
for osteoporosis so it is recommended that they are screened as well.
TH: Thank you, Dr. Faulkner.
Rethinking osteoporosis
by Susan E. Brown, Ph.D., CCN
Bone Depleting Factors
- Acid/alkaline imbalance
- Tubal ligation
- History of dieting
- Nutritional deficiencies
- Underweight
- Caffeine
- Inadequate peak bone mass
- No exercise
- High protein
- Low calcium
- Sugar
- Hysterectomy
- Junk food
- Poor bone repair
- High fats
- Early menopause
- Stress
- Ovary removal
- Weak digestion
- Rugs
- Weak adrenals
- Irregular periods
- Tobacco
- Endocrine imbalance
- Alcohol
|
At the Osteoporosis Education Project we have been
rethinking the true nature, causes and best prevention
and treatment of osteoporosis for over a
decade. We now know that osteoporosis is a rather
complicated disorder often presented as a simple
problem of bone mineral loss. Stepping back and
rethinking osteoporosis from a cross-cultural, anthropological perspective
has allowed for the development of critical, new insights
into this crippling bone disorder.
Rethinking osteoporosis from a broader anthropological perspective
we have found that the basic nature of osteoporosis is somewhat
different than commonly held. The table below highlights the
nature of osteoporosis as seen from a broader, more holistic perspective.
Rethinking the Nature of Osteoporosis
Osteoporosis Is Not . . .
Just thin bones
Normal aging bone loss
Common all over the world
A female disorder
A disorder of just the elderly
Faulty bone metabolism, something that “goes wrong” with our bones
An isolated disorder
Rather, Osteoporosis Is . . .
Thin and substandard bone
A degenerative disease
Common only in Westernized countries
A “feminist issue” in Westernized countries
Becoming more common among the young
An intelligent bodily response to the stress of long-term imbalance
One manifestation of systemic breakdown
Rethinking the Best Prevention and
Treatment of Osteoporosis
Recognizing the complexity of osteoporosis, we
at the Osteoporosis Education Project have
developed a comprehensive Eight Step Program
for Bone Health Maximization. Each of the
eight steps is life supporting in itself, making
this program one that builds better bones and a
better body.
These eight steps involve:
- Maximizing Nutrient Intake
- Minimizing Anti-Nutrients
- Building Digestive Strength
- Development of the Alkaline Way Diet
- Exercising into Bone Health
- Promoting Endocrine Health
- Considering Alternatives to Estrogen Drugs
- Testing Your Program's Bone-Building Power
One way to measure the success of your personal
program is to obtain a bone density scan of
the spine and hip. Ideally a baseline scan should
be taken before beginning your program and
follow-up measurements done to gauge the success
of your efforts. In the beginning, follow-up
exams are usually scheduled at one year. Later
they can be spread out more if your results are
right on target. For accuracy, it is important
that the baseline and follow-up exam are done
on the same type of equipment. Today the stateof-
the-art bone scan device is known as the
DEXA scanner.
Susan E. Brown, Ph.D., CCN directs The
Osteoporosis Education Project and the
Nutrition Education and Consulting Service in
Syracuse, New York. Serving health professionals
and the interested public, she conducts primary
research, lectures widely on osteoporosis
and teaches the use of holistic, natural programs
for bone health maintenance and regeneration.
For further information on The Osteoporosis
Education Project visit www.betterbones.com
Dr. Brown's book is Better Bones, Better Body
Beyond Estrogen and Calcium—Second Edition
(Keats Publishing, 2000).
|
