Debra, a 45 year old woman, had a shocking year when she broke a tooth and broken a toe. Together, this strange series of events led her doctor to investigate her bone health more deeply. Debra was shocked to find that both her parents had experienced osteoporotic fractures. In turn, her doctor prescribed a bone density scan, a specialized X-ray that tells how dense, or strong, your bones are.
Even without her violin, the scan was a major life event for Debra. This might have even contributed to her fractures, as well. Looking at Debra’s family’s medical history, her healthcare team knew they had to take action immediately. To reduce her perimenopause symptoms and increase her bone density, they prescribed hormone replacement therapy. Further, she was advised to increase the amount of vitamin D and calcium she was taking by adding in supplements with both nutrients.
Debra enjoys running and going to the gym, keeping herself active nearly every day. We had a female health specialist early on who urged her to continue this practice. What those unanticipated breaks did was cause her to doubt what’s going on with her general health and the condition of her bones.
The Significance of Bone Density Scans
Bone density scans are key diagnostic tests that can determine a person’s long-term risk of osteoporosis. Taking about 15 minutes on average, these scans—which are much like a CT scan—measure bone density mostly in the hip and spine, the most fracture-prone areas. Currently the cost of a scan ranges from $80 to $120. This price point puts it within reach for the majority of individuals who prioritize their bone health.
If you’ve received a diagnosis for osteoporosis or are at risk, particularly if you are over the age of 70, the government offers rebates. These rebates go a long way toward reducing the sticker shock of obtaining important scans. There is a growing demand for reform to this old practice. Mr. Lyubomirsky, a longtime proponent of improving the healthcare policy landscape, has been working to lower the automatic age limit for rebates from 75 to 65.
“We’re just trying desperately trying to find the right surrogate for assessing our risk of fracture.” – Dr. Sztal-Mazer
Furthermore, research has made clear in recent years how critical these scans are to identifying those at risk. Professor Ego Seeman, an endocrinologist and bone biologist at Austin Health, puts his finger on the nub of the matter. He points out that bone mineral density machines can only predict around 30 percent of fractures occurring over eight years. When micro-architecture assessments are included in the detection process, the true positive detection rate jumps to 89%.
“The bone mineral density machine picks up 30 percent of the fractures that occur over eight years, whereas when you add the micro-architecture, it picks up 70 percent.” – Professor Seeman
Understanding Osteopenia and Its Implications
Osteopenia functions as a key messenger in that capacity. It simply means that your bones are less dense than they ought to be, but they haven’t yet deteriorated into the osteoporosis category. For people such as Debra, this diagnosis can be life-changing. The loss of bone mineral density increases the fracture risk. For each point that goes below zero, that risk goes up by 1.5 to 2 times.
Debra’s story illustrates how important it is to identify risk factors for osteoporosis. This is particularly critical for people who may have a family history of bone health concerns. Healthy Bones Australia provides a range of resources including an online survey designed to assist people in assessing their level of risk for osteoporosis. Those results can then be taken to healthcare providers to start conversations about what next steps might be right for you.
“It would be justified for anybody over 50 to have a [bone density scan], especially women over 50, then you know what your baseline is and what your drop is later on.” – [Source Not Specified]
Debra was proactive, going to the doctor after experiencing suspicious fractures. She had a bone density scan, reminding us all that it’s very important to stay proactive and attentive to your bone health.
Recommendations for Maintaining Bone Health
Given her diagnosis, Debra has done a lot to change her lifestyle in order to strengthen her bones. Having a physically active lifestyle is key, but weight-bearing exercises and resistance training are especially good at keeping bones dense. We believe that nutrition is the bedrock of your health. To promote the best bone health, ensure you’re receiving adequate calcium and vitamin D!
Along with lifestyle changes, having regular screenings and checking in with healthcare professionals can ensure bone health is monitored over time. This will involve empowering patients to have conversations about their family history of disease and symptoms they might be experiencing.
Dr. Sztal-Mazer advocates for new approaches to determine fracture risk. She beautifully drives home the need for more research to be done in this fundamental field.
“If you use bone mineral density, you’ll only pick up about 20 to 30 percent of the people who break bones.” – Ego Seeman
