Trying toAre you at risk for silent bone loss? Your body begins to lose bone faster than it forms as you get older. This process is gradual; there are no symptoms, warning signs, or pain.
Bone is an active and living tissue. It is constantly breaking down and rebuilding itself. goes completely undetected until a fracture occurs. Your body makes more bone than it can lose until your late 20s, when it reaches what is known as peak bone mass. After the 20s, this situation gets completely changed. But women are at major risk of bone loss after menopause, when levels of estrogen, a hormone directly involved in bone resorption, decrease. In men, it occurs less rapidly but is clinically more important after the age of 70 years.
Most often, a bone density test (also known as a DEXA scan) is the clinical instrument used to identify this bone loss before a fracture occurs.
What Is a Bone Density Test?
A bone density test is a medical imaging procedure used to assess the amount of mineral in and the density of your bones. It is given in grams of mineral per square centimeter of bone area. The more your bones are dense, the stronger and more fracture-resistant they will be.
The most widely accepted and most clinically useful bone density test is called Dual-Energy X-ray Absorptiometry (DEXA scan). Your spine and hip are photographed by the machine. It does not look at soft tissues in your body to determine your actual bone density. Will provide you with accurate figures. Without a scan, you have no idea what’s going on with your bones.
There are no injections, no preparation, and no discomfort needed. During this time, you stay well-dressed and lie still on a padded table as the scanner moves over you for about 10-20 minutes.
Other Types of Bone Density Tests
The most widely used and most clinically tested instrument is the DEXA scan. Some other bone density assessment methods exist:
Peripheral DEXA (pDEXA): This scan assesses bone density of the peripheral areas such as the wrist or foot. It is used as a screening tool in some community settings, but not as effective as central DEXA for the diagnosis of osteoporosis or for determining treatment.
Quantitative CT (QCT): It provides a three-dimensional measurement of bone density and can distinguish between cortical and trabecular bone. This test is more sensitive than DEXA in some applications, but it is expensive and needs more radiation.
Quantitative ultrasound (QUS): It relies on sound waves instead of radiation to measure bone at peripheral sites such as the heel. Low cost and radiation-free, but not suitable for diagnosis or treatment monitoring. This is used as a screening tool only.
Vertebral fracture assessment (VFA): This is an extra scan performed in conjunction with a DEXA scan that takes a picture of the spine to look for existing vertebral fractures. It is a major risk indicator even if your BMD is not low.
Central DEXA scan of the spine and hip is the only method recommended by the World Health Organization for diagnosing osteoporosis and guiding treatment decisions. All other techniques are used as screening or ancillary techniques.
Who needs a DEXA scan?
It is not advisable to book a test independently. A DEXA scan should be performed after your bones have reacted to lifestyle changes or medical treatments. It is highly recommended for:
- All women aged 65 and older
- Postmenopausal women
- Women with early menopause before age 45
- Women who have experienced fragility fractures
- All men aged 50-70 and older
Adults of Any Age with Specific Risk Factors or Conditions:
If you are exposed to these factors, you should also be screened before it’s too late:
- Long-term steroid use: If you are taking prednisone or equivalent at 5mg or more daily for 3 or more months is one of the most significant risk factors for secondary osteoporosis. The American College of Rheumatology advises doing a DEXA scan at the beginning of long-term steroid therapy.
- Rheumatoid arthritis: Both the disease itself and its treatment with glucocorticoids significantly accelerate bone loss. All patients with a known diagnosis of RA are recommended to have bone density testing.
- Irritable Bowel Disease: If you have IBD, the chronic inflammation depletes calcium and vitamin D, and frequent use of steroids negatively affects bone density.
- Celiac Disease: In treated, asymptomatic celiac disease, malabsorption can markedly decrease bone mineral density. Baseline DEXA is recommended at diagnosis, and follow-up DEXA monitoring is also recommended.
- Kidney disease and Hyperparathyroidism: It is recommended to get a DEXA scan if you have Hyperparathyroidism and stage 3 kidney disease.
- Type 1 diabetes: You need a DEXA scan with Type 1 diabetes. Because it is highly associated with lower bone density and higher fracture risk, independent of your BMI and any other factors.
- Inactivity: Your bones need mechanical load in order to maintain their density. Any extended bed rest or immobilization leads to measurable loss of bone in weeks.
Roughly 80,000 hip fractures occur each year in the U.S. among men, and men are much less likely to be screened, diagnosed, or treated for osteoporosis than women. The short-term mortality rate for men with hip fracture is higher than that of women with hip fracture.
If you are a man over age 50 and have any of the above risk factors, talk to your provider directly about a bone density test.
How Often Should You Have a Bone Density Test?
The frequency of DEXA scans will depend on baseline results, risk factors, and whether the patient is being treated for bone loss. Scanning too often is costly and exposes patients to more radiation, but provides no clinical data.
Timing is a very important factor when it comes to a DEXA scan. It takes your bones at least 1 to 3 months to show measurable improvements. If you’re tested too early, the scan will indicate no progress.
Trying to request another scan too early, your insurance company won’t pay for it.
If you have a normal bone density and are at low risk, you need to get a scan every 10 to 15 years. There is no such clinical need for a more prompt second repeat in the truly low-risk individual.
What Causes Bone Loss?
The highest bone mass is achieved between the ages of 25 and 30. After this, the balance slowly tips towards resorption and the net mass of bone starts to diminish. Several factors speed this up and cause faster bone loss than the age-induced bone loss:
- Menopause: It has been observed that women lose 10-20% of their bone density within the first 5-7 years after menopause.
- Men with low testosterone: Testosterone plays a role in maintaining bone density in men. Hypogonadism is a major and unrecognized contributor to osteoporosis in males.
- High cortisol or Stress: This can occur in Cushing’s syndrome or due to exogenous steroids use, and directly inhibits osteoblast function and stimulates osteoclast activity at the same time.
Some other factors may include:
- Calcium deficiency
- Vitamin D deficiency
- Protein deficiency
- Physical inactivity
- Smoking
- Excessive alcohol
- A very low BMI (under 18.5 to 21)
How to Improve Your Bone Density?
You can’t simply wait for your bones to heal. It is essential to encourage bone growth. Here’s what to do:
- Protein Intake: Protein is the main component used to build bone. You need to get sufficient protein at every meal to provide the building blocks for your body.
- Progressive weight-bearing exercises: You should focus on progressive, weight-bearing exercises. When you lift weights, the bones are stretched physically. This is mechanical stress, which tells your bones to grow denser and stronger.
- Medical treatments: You must consult your GP. Lifestyle changes may not be enough, so your provider may prescribe medications that promote bone growth. HRT should be discussed for postmenopausal women. Also, if you have an underactive thyroid or rheumatoid arthritis, you may be able to get a treatment to correct those underlying conditions so that rapid bone loss will stop.
If You Have Never Had a Bone Density Test:
Here is what you should do:
- Check if you are eligible for screening. If you are a woman age 65 or older, a man age 70 or older, or a younger adult who has any of the risk factors mentioned in this article, you are a candidate for a bone density test.
- Ask your primary care provider: Request a DEXA scan referral specifically and mention your risk factors.
- Maintain a Healthy Lifestyle. Calcium intake, vitamin D levels, and weight-bearing exercise, as well as fall prevention benefits, are seen at all levels of bone density. Don’t wait for a scan result to begin improving the health of your bones.
If Your Results Show Osteopenia:
- Ask your provider to calculate your FRAX score. This will show you the true 10-year fracture risk and whether you need to start pharmacological treatment at this time or whether lifestyle modification and monitoring are enough.
- Take a close look at your calcium and vitamin D consumption. Most people greatly underestimate the amount of calcium they consume from food. Record what you eat in a food diary or app for one week to find out how much you eat each day. A supplement is recommended if you are routinely below 1,000-1,200 mg.
- If you have not had a 25(OH)D blood test, get one. Vitamin D deficiency is very prevalent and can be readily treated. This gives you the chance to supplement exactly whether you need to or not.
- Start a regular resistance training program. Weight-bearing and resistance activities such as squats, lunges, deadlifts, rows, exercises directly on the bones, and provide 2-3 sessions each week. A physiotherapist can provide you with a program that is suitable to your fitness and current bone status.
If Your Results Show Osteoporosis:
- Discuss the entire treatment conversation with your provider: A T-score of -2.5 or lower is most often considered an appropriate time for pharmaceutical treatment. Specifically ask what medicine is best for you, how long you will need it for, and what the monitoring plan will be.
- Discuss vertebral fracture assessment (VFA). A VFA scan of the spine can detect current vertebral fracture(s) if not done with your DEXA, and can significantly alter your fracture risk profile if you have a vertebral fracture.
- Check all medicines with the provider. There are other medications used regularly besides steroids that impact bone density, such as proton pump inhibitors (long-term), some antidepressant drugs (SSRIs), anticonvulsants, and heparin. Discuss if any of your medications are contributing or if there are alternatives.
- Never discontinue prescribed bone treatment without talking to your provider. Patients sometimes stop using bisphosphonates when they experience side effects without realizing the importance of stopping. Discontinuation should be a well-thought-out and supervised decision, not a one-sided decision.
The Bottom Line
Taking a daily multivitamin will not fix the problem of bone protection. It demands careful attention to your nutrition, mechanical load, and medical therapy.
One of the simplest, lowest-risk, and most helpful preventive tests in primary care is a bone density test (DEXA scan). If your results show bone loss, you can use proven, readily available methods to reverse the damage.
At Kairos Integrative Care, Lola, one of our integrative practitioners, provides evidence-based chronic disease management, screenings like DEXA scans, and personalized treatment plans to help patients improve long-term health outcomes.
We see patients in Houston, Sugar Land, Richmond, and nearby areas (77046 & 77478), and accept major insurance plans including Blue Cross, Aetna, Ambetter, Cigna, and more.
New patients are always welcome, and if visiting the clinic isn’t possible, telemedicine appointments are available across Texas.
Book your appointment today!
