Bone Density

What you don’t know can hurt you after all — at least when it comes to the significant loss of bone density known as osteoporosis, a condition in which the bones become weak and can break more easily.

How strong your bones are and how susceptible they are to breaking is, in basic terms, referred to as your bone density. Higher bone density indicates stronger bones, while lower bone density may indicate bone weakening, which can lead to conditions like osteoporosis.

Osteoporosis typically develops gradually over time and tends to affect some groups of people more than others due to various risk factors. Because osteoporosis can often go unnoticed until a fracture occurs, it’s important to recognize these factors for early detection and prevention.

Risk Factors for Osteoporosis

Osteoporosis isn't just for grandma — it can sneak up on anyone. There are some things that might increase your chances of developing it. These risk factors can be divided into two categories: those that cannot be changed and those that can be modified through lifestyle changes.

Women over the age of 65 and men ages 50-70 are at increased risk of osteoporosis if they have:

• A broken bone caused by normal activities, such as a fall from standing height or lower
• Chronic rheumatoid arthritis, chronic kidney disease, eating disorders
• Early onset of menopause (before age 45)
• History of hormone treatment for prostate cancer or breast cancer
• Significant loss of height due to compression fractures of the back
• Three or more drinks of alcohol per day on most days
• Family history of osteoporosis or fractures
• Long-term use of medications that affect bone density (e.g., corticosteroids)
• Lifestyle factors like smoking, excessive alcohol consumption, and sedentary behavior

Having one or more risk factors does not mean that you will have osteoporosis. However, the more risk factors you have, the greater your chance of developing the disease. 

What is Bone Density Screening?

A great way to get out ahead of osteoporosis before a bone breaks is through screening. Bone density screening, also known as bone densitometry or dual-energy X-ray absorptiometry (DEXA), is a diagnostic test used to measure bone mineral density (BMD). It helps in assessing the strength and density of bones, particularly in areas prone to fractures such as the spine, hip, or wrist.

This non-invasive procedure utilizes low-dose X-rays to detect signs of osteoporosis or osteopenia (a precursor to osteoporosis).

According to the US Preventive Services Task Force, DEXA bone density screenings are recommended starting at age 65 for women at an average risk of osteoporosis. While no screening guidelines exist for men, they may consider talking to their doctors about the screening starting at age 70.

What to Expect During Screening

Thankfully, you don't have to do much to get ready for a bone density test. Just make sure to talk to your doctor if you have any questions or worries before your scan. Before your bone density test, your doctor will explain what will happen during the test and answer any questions you have.

This imaging scan is simple and fast. It doesn't hurt, and it only uses a small amount of radiation. Most of the time, your appointment will be over in less than 30 minutes.

Before your bone density scan:

• No special diet needed. Just stick to your regular eating and drinking habits.
• Don't take any vitamins, calcium supplements, or other mineral supplements for 24 hours before your test.
• Choose clothes without metal, like zippers, underwire bras, belts, or jewelry, to make the test more comfortable.
• Don't forget to bring your photo ID and insurance card to your appointment.
• Make sure it's been at least 3-4 days since you had any contrast studies done.

During a bone density scan:

• You will lie on a padded table while a scanning arm passes over your lower spine and hip, or over your wrist, fingers, leg or heel — all areas prone to fractures.
• The procedure is painless and typically takes 10 to 30 minutes, depending on the areas being scanned.
• For DEXA scans, radiation exposure is minimal, equivalent to that of a cross-country flight.
• You may need to wear loose, comfortable clothing and remove metal objects that could interfere with the scan.

Types of Bone Density Scores: T-Score and Z-Score

Bone density test results are typically reported as T-scores and Z-scores:

• T-Score: This score compares an individual's bone density to that of a healthy young adult of the same gender. A T-score of -1.0 or above is considered normal, while scores between -1.0 and -2.5 indicate osteopenia (low bone mass). A T-score of -2.5 or lower signifies osteoporosis.
• Z-Score: Unlike the T-score, the Z-score compares bone density to that of individuals of the same age, gender, and ethnicity. A Z-score below -2.0 may indicate lower-than-expected bone density for one's age group, suggesting the need for further evaluation.

After the screening, your doctor will interpret the results and discuss them with you. Based on your bone density scores and other risk factors, they will determine your risk of fractures and recommend appropriate management strategies, which may include lifestyle modifications, medications, and dietary supplements.

The Benefits of Bone Density Testing

Regular bone density screenings are essential for early detection of bone loss and osteoporosis, allowing for timely interventions to prevent fractures and maintain bone health.

Additionally, regular bone density assessments can help evaluate the effectiveness of osteoporosis medications, guiding treatment adjustments as needed to optimize outcomes.

By quantifying bone density, DEXA scans can help your doctor have a clearer idea of your individual risks, allowing for targeted preventive strategies.

Insurance Coverage for Bone Density Screening

Because bone density screening can be an amazing diagnostic tool when it comes to getting out ahead of osteoporosis, Medicare Part B covers 100% of the cost of bone density tests every 2 years if you meet the eligibility requirements, which include being an estrogen-deficient woman at risk for osteoporosis, having vertebral abnormalities, taking long-term steroids, or being monitored for osteoporosis treatment.

Medicare Advantage plans are also required to cover bone density tests without deductibles, copays, or coinsurance when you meet the eligibility criteria and see an in-network provider.

Medicare will also cover follow-up measurements and/or more frequent screening if your doctor prescribes them.

Many private health insurance plans will cover bone density tests, but the coverage can vary. You should check with your insurance provider ahead of time to see if the test is covered under your plan, as not all plans may pay for it.

Reducing Further Bone Loss and Prevention

If you’re diagnosed with osteoporosis or a less severe form called osteopenia (a precursor to osteoporosis), your doctor will recommend some comprehensive management strategies aimed at preventing further bone loss and reducing fracture risk.

Treatment may include:

• Medications: Various medications, such as bisphosphonates, selective estrogen receptor modulators, and denosumab, are prescribed to enhance bone density and reduce fracture risk.
• Calcium and Vitamin D Supplementation: Adequate calcium intake, typically supplemented with vitamin D to optimize absorption, is essential for maintaining bone health and minimizing bone loss.
• Weight-Bearing Exercise: Regular physical activity, particularly weight-bearing exercises like walking, jogging, and resistance training, stimulates bone remodeling and helps preserve bone density.

Following these preventive measures, along with making lifestyle changes like quitting smoking and moderating alcohol consumption, is crucial for managing osteoporosis and protecting bone health.