5 things to know about bone density testing for women

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FEATURE — The National Institute of Health has updated recommendations regarding bone density scanning, so I thought I would go through it because if you do a Google search on the topic, even material from 2013 is now outdated.

Here are five things to know about new recommendations for dual-energy X-ray absorptiometry, more commonly known as DEXA.

Women at normal risk do not need a DEXA scan until they are 65.

There is no benefit to getting one earlier unless there are risk factors, such as early menopause, strong family history, smoking, et cetera.

Scans do not need to be repeated every year.

There is no benefit to doing scans any sooner than every three years. Women with very normal bone density can be spaced to five to eight years. Most bone loss occurs in the first seven years after menopause. After that, bone loss still occurs but is much more gradual. That’s why if your screen at age 65 looks good, your odds of getting a fracture are quite minimal.

Calcium and vitamin D supplementation is recommended.

Even though there is no conclusive data showing that calcium and vitamin D decreases osteoporotic fractures, they are recommended by most doctors for post-menopausal women. I find that strange, but maybe that will sort out sometime in the future.

Bones are constantly being remodeled. You need calcium as a building block. You need vitamin D to absorb it and get it to the bones. But to get it into the bones and form new matrix, things such a vigorous exercise, estrogen and a variety of medication can help do that. So it is much more complicated than popping a few vitamins every day. And your genetics plays a role we are just beginning to understand.

Treating mild osteopenia (thinning bones) can potentially do more harm than good.

More testing and more aggressive treatment is not advantageous in this case.

Treating osteoporosis is dependent on your FRAX score.

Current recommendations are to treat osteoporosis if your 10-year risk of hip fracture is over 3% or your risk of other significant fracture – spine, long bones, et cetera – is over 20%. This is called your FRAX score, and with the results of your DEXA scan, it is something that you can calculate yourself.

To find your score, do a Google search for  “FRAX calculator” and just follow the instructions. These are solid guidelines, and these are national standards of care. Remember, being more aggressive not only may not improve your outcome, but the risks of treatment likely outweigh the benefits. It’s your body. Educate yourself and be an active participant in your health care.


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