Health Column: Do you really need a bone density test?
This week let’s “bone up” on a screening test that has been widely recommended: the DEXA (dual-energy x- ray absorptiometry).
This test measures the density of certain bones that we frequently break — hip, wrist, and the vertebrae in the lower back. The concept is sound — identify people with decreased bone density (and strength) and thus at risk for fracture, and treat them with medications that help build bone!
For many years, physicians recommended DEXAs for women of all ages and some men as well. Now there is good evidence that for women without risk factors, bone density screening should not start until age 65 and for men at age 70. The risk factors that should prompt earlier screening are a history of a previous fracture from a minor injury, rheumatoid arthritis, a parent with a hip fracture, or a history of smoking, heavy drinking or long-term use of corticosteroids.
Why the change in screening guidelines? The prevailing notion has been that the earlier a condition was identified, the more likely a positive outcome. Physicians have focused almost entirely on the benefits of screening tests, but have rarely discussed the liabilities. We now know that bone density screening done on younger persons identifies “patients” with minimal-modest bone loss. These “patients” are frequently treated with osteoporosis medications, but rarely benefit and are exposed to the expense ($150) and the common risks of these drugs, like gastrointestinal irritation and bleeding.
HOW CAN YOU KEEP YOUR BONES HEALTHY?
Engage in 30 minutes of weight bearing exercise a day — walking or weight lifting.
Aim for 1,200 milligrams of calcium per day, using green leafy vegetables or low fat dairy products or a supplement.
Consider a vitamin D supplement if you are a woman post-menopause or get little sunshine. Six hundred international units a day is recommended and 800 I.U. if you are 70 or older.
Talk to your physician and check out http://www.ChoosingWisely.org — a great resource for learning what medical tests and procedures to avoid.
GJ Free Press health columnist Dr. Mohler has practiced family medicine in Grand Junction for 39 years. He has a particular interest in pharmaceutical education. Phil works part-time for both Primary Care Partners and Rocky Mountain Health Plans. Email him at firstname.lastname@example.org.
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