Screening for osteoporosis is now routinely performed in our office, with the goal of detecting a decrease in bone density before there is a fracture. Foxhall Internists, P.C. offers a test of bone density called Bone Densitometry (DEXA). Below are more facts. If your bone density is found to be lower than it should be, a number of medications are available which either reduce the chance of further bone loss, or in some cases help to rebuild bone.

1. What is a dexa scan?
DEXA or (DXA) stands for Dual-Energy X-ray Absorptiometry, which is the gold standard test to detect osteoporosis. It is an X-ray that is safe, quick and painless. The amount of radiation exposure is less than that of a routine chest x-ray.

2. What is osteoporosis?
Osteoporosis is defined as a decrease in bone mass or density due to calcium loss. This causes changes in bone architecture, which can lead to an increased risk of fracture. Osteoporosis is responsible for 1.3 million fractures per year in the United States. Many of these fractures are of the hip, which can cause significant medical complications and overall health problems. Compression fractures of the spine are also common. These cause severe pain and lead to disability and loss of independence. In fact, it is estimated that more than half of women in the U.S. will experience fractures due to osteoporosis during their lifetime. Men can also have osteoporosis. Osteoporosis causes no symptoms until a fracture occurs. Therefore, it is important to know about osteoporosis so treatment can be given to prevent fractures.

3. What are the risk factors for osteoporosis?

  • Increasing age
  • Estrogen deficiency, either postmenopausal or surgical
  • Family history of osteoporosis
  • Caucasian or Asian heritage
  • Low body weight (<127 lbs.)
  • Early or surgical menopause
  • Low calcium diet
  • Cigarette smoking
  • Inactive lifestyle
  • Excessive alcohol or caffeine intake
  • Certain diseases may cause osteoporosis: Hormonal disorders, eating disorders such as anorexia or bulimia; hypogonadism, hyperparathyroidism, lymphoma, leukemia, multiple myeloma, rheumatoid arthritis, sarcoidosis, hyperthyroidism
  • Medications can also cause osteoporosis including: anticonvulsants, chronic corticosteroids, heparin, and lithium

4. Who should have a dexa scan?
Anyone who is at risk for or who has symptoms of osteoporosis should have a DEXA scan. The National Osteoporosis Foundation recommends that bone density measurements be made on:

  • Anyone with risk factors for osteoporosis
  • All postmenopausal women under age 60 who have one or more additional risk factors for osteoporosis
  • All women aged 60 and older regardless of risk factors
  • Women who have been on hormone replacement therapy for prolonged periods
  • Anyone beginning or taking chronic steroids
  • Anyone with unexplained fractures
  • Anyone who has lost over an inch of height

5. What is involved in taking this test?
Bone densitometry only takes 8-10 minutes in the actual scanner. It requires no previous preparation. No dye or needles are involved. The test routinely scans the hip and the spine. The forearm can also be scanned.

6. How is the scan interpreted?
The scan usually measures the density in the lumbar spine and the hip. The scores are reported both as a T-score and a Z-score. T-score represents the number of standard deviations compared with the normal “young adult” mean bone density.

WHO (World Health Organization) standards are:

  • T-score above -1 are normal
  • Between -1 and -2.5 is defined as osteopnia (thin bones or slightly low bone mass)
  • Below -2.5 is defined as osteoporosis

Z-score represents the number of standard deviations compared with age, race, and sex matched mean bone density. This is not used to make a diagnosis of osteoporosis, but if significantly low, can be indicative of an underlying health disorder causing osteoporosis.

7. How can I find out if bone densitometry is right for me?
Talk with your physician about your concerns. He or she will be glad to discuss your risk factors for osteoporosis and treatments available.

8. What are some of the treatment options available?
Treatment usually consists of a combination of proper amounts of calcium, vitamin D, and weight bearing exercise. Quit smoking and avoid excessive alcohol use. Often prescription medications will be prescribed for osteopenia or osteoporosis. Your physician can evaluate the risks and benefits of taking a medication depending on your health history.

9. What are the daily calcium requirements?
The National Institutes of Health recommend the following calcium intake:

Children and Teens 9 through 18 years     1300 mg
Adults 19 through 50 years                1000 mg
51 years and older                        1200 mg
Pregnancy                                 1200 mg
Postmenopausal women on estrogen          1200 mg
Postmenopausal women not on estrogem      1500 mg

10. How can I best fulfill calcium requirements?
Diet and calcium supplements are the best way to get the daily requirement.

Calcium Content of Food
Food                      Serving size    Calcium (mg)
Milk                      1 cup           302
Yogurt                    8 oz.           300
Cheddar Cheese            1 oz.           200
American Cheese           1 oz.           174
Figs                      10 figs         269
Tofu                      1/2 cup         258
Calcium containing OJ     6 oz.           200
Cottage Cheese            1 cup           126
Sardines, canned in oil   2 sardines       92
Broccoli, boiled          1/2 cup          36
Vanilla ice cream         1 cup           176

11. Are all calcium supplements the same? how should they be taken?
The total daily calcium should be spread throughout the day. It may be easiest to have one or more calcium rich items with each meal. Both dietary sources and supplements can be used to reach the requirement. Do not take more than 600 mg of supplement at one time as calcium is poorly absorbed. Calcium citrate seems to be better absorbed than calcium carbonate, but there are more forms of calcium carbonate available. The main point is to take a supplement that you tolerate and will take regularly.