An important tool for women’s health

(SOUTH YARMOUTH) – Most women are savvy about getting their yearly mammograms, but there’s another less-discussed screening that is also important: a bone density scan. A bone density scan is just what it sounds like. It’s a quick and easy test to see how dense your bones are. The results reveal how likely you are to develop osteoporosis.

“The U.S. Preventive Services Task Force recommends screening bone density tests beginning at age 65,” said Nurse Practitioner Kelley Murphy.

For the most part, bone density scans are only done on women. There isn’t enough evidence to recommend that men do routine screening for osteoporosis, she said. The reasons include hormones and body size. In general, men have larger bones than women, which offers them protection.

Aside from being a woman, there are other risk factors that might mean you should be screened earlier than age 65, said Murphy, who practices at Yarmouth Primary Care in South Yarmouth.

“The standard is post-menopause because it’s during those first 10 years of menopause when you’re going to lose the most bone mass,” she said.

Risk Factors

Risk factors that put women at higher risk of osteoporosis include:

• Going through menopause early.
• Family history of osteoporosis.
• Parent who had a hip fracture.
• Previous fracture yourself.
• Taking steroids.
• Being a cigarette smoker.
• Drinking excessive alcohol.
• Having an eating disorder.
• Insufficient calcium in childhood.
• History of rheumatoid arthritis.
• History of inflammatory bowel diseases like Crohn’s disease or colitis.
• Low body weight.

“A common scenario I see is a postmenopausal woman with a low BMI. She is at high risk for osteoporosis because she has had less weight on her bones to build their strength. The second most common scenario I see is a woman who went through menopause early. She has had less exposure to the hormone estrogen, which builds bone strength. If you add these two scenarios together, osteoporosis is likely.”

Self-Scheduling Available

Anyone with one or more of those risk factors should discuss with their healthcare provider whether an earlier bone density scan might be recommended, she said. Once a physician referral is ordered, a patient can go into their Cape Cod Healthcare MyChart account to set up their own appointments for a bone density scan.

Women can get bone density scans at all of the same sites that perform mammograms: Fontaine Outpatient Center in Harwich, Cuda Women’s Health Center in Hyannis and Seifer Women’s Health and Imaging Center in Falmouth. Many women schedule their bone density scan at the same time as their mammogram for convenience, Murphy said.

The test itself takes from 10 to 20 minutes. It uses X-ray technology to measure the amount of calcium and other minerals in your bones. The most common bones that are tested are hip, spine and sometimes forearms. The test is done on a flat open table with an upper arm that the technician moves over your body. Once a radiologist reviews the scans, the results will appear in MyChart.

“The results will tell you how dense your bones are,” Murphy said. “The result will be displayed as a T-score and that’s the number you will see on MyChart.”

What T-Score Tells You

The T-score tells you how much your bone mass differs from a healthy 30-year-old. A T-score of negative 1 means that you have lost 10 percent of your bone mass compared to when you were 30. A T-score of negative 2.5 means you have lost 25 percent of your bone mass. Normal bone density is less than 10 percent loss. A percentage between 10 and 25 percent means you have osteopenia. A score of more than 25 percent means you have osteoporosis.

Murphy has seen scores as low as negative 3.5, meaning a dangerous 35 percent loss of bone mass.

“It’s normal that we lose some bone mass as we age but we don’t want to lose too much,” she said. “If it’s a T score below negative 1, we’re concerned about fracture risk.”

The other score you will see on your MyChart is a Fractured Risk Assessment Tool or FRAX score. That number tells you how likely you are to have a fracture due to osteoporosis in the next ten years. A score of more than 10 percent for overall fractures or 3 percent for hip fractures is concerning, Murphy said.

“We care about bone strength because fractures can be devastating for people in terms of pain, hospitalization and loss of independence,” Murphy said. “We screen women at 65 but we are really thinking about fracture prevention for these women in their 80s and 90s when they are more prone to falls.”

Prevention Tips

There are things women can do to protect their bones. The first things Murphy recommends are lifestyle changes that include:

• Weight bearing exercises. Tennis and basketball are especially good choices but walking with hand or ankle weights can also help.
• Smoking cessation.
• Limiting or eliminating alcohol.
• Adequate calcium consumption.
• Over-the-counter vitamin D supplement (600 units is adequate for most women).

If you have an abnormal bone density, your doctor will also order a test for Vitamin D levels and discuss if additional supplement is needed. If your diet is deficient in calcium, your doctor may recommend a supplement, but Murphy warned against taking a calcium supplement before talking to your provider. This is because taking a lot of excess calcium can cause calcium to deposit in the arteries, making you more susceptible to heart disease.

Once you have your baseline bone density, how often to rescreen depends on the results.

“If you have normal bone density the first time you screened, then you wouldn’t need another one for four years. But if you have some bone loss, then you would need another bone density at two years.”

Cape Cod Health News