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You
have all heard the term
osteoporosis, a condition
where the bones are not as
mineralized/dense/strong as
they should be, placing that
person at increased risk of
fracture.
For wrist fracture
secondary to a fall onto
one’s extended arm; for
vertebral fracture with
resultant deformity in
appearance and, if severe,
difficulty in ambulating and
breathing properly; and most
problematically, for hip
fracture.
The resulting
immobilization can have
disastrous effects.
A total of 40-50% of
people with a hip fracture
aged 80 and above and 20-25%
of people age 70-80 will not
live out the year after
their hip fracture because
of the blood clots,
pneumonia and other maladies
that accompany prolonged
immobilization.
The World Health
Organization estimates that
at least ten and possibly as
many as 20 million men and
women in the United States
have osteoporosis and are at
significantly increased risk
for fracture.
Although
there are treatments
for osteoporosis, the best
therapy is prevention.
You don’t want to
get osteoporosis.
“Osteopenia”
(defined as a bone mineral
density greater than one but
less than 2.5 deviations
below the mean) is a
warning.
It still increases
your fracture risk, but no
where near as much as
osteoporosis (a bone density
of greater than 2.5 below
the mean).
It is a warning to
get treated!
Bone
mineral density problems are
much more prevalent in women
compared to men.
Why?
Both testosterone and
estrogen protect against
bone loss.
Although men’s
testosterone certainly wanes
with age, men do not
experience the virtual
disappearance of their
protective sex steroids that
women do.
Measuring
bone mineral density in
older patients (over 50 or
60 years), especially
in women, is as justifiable
as measuring lipids.
Lipid testing and
treatment for high
cholesterol is accepted as
an integral part of primary
care, but bone densiometry
and therapy for low bone
density aren’t as readily
accepted, partly because
measurements and treatments
for osteoporosis came along
well after tests and
treatments for heart disease
and its risk factors.
The
cost-effectiveness of bone
density testing stacks up
nicely against the value of
lipid testing; people with
cholesterol measurements in
the highest quartile have
four times the risk for
heart disease compared with
people whose measurements
are in the lowest quartile,
whereas the risk for hip
fracture increases tenfold
in people whose bone density
is in the highest quartile
compared with those in the
lowest quartile.
Heart disease risk
increases from about 0.5% in
the lowest LDL quartile to
approximately 4% in the
highest lipid quartile.
Hip fracture risk
increases from approximately
0.5% in the highest quartile
to approximately 10% in the
quartile with the lowest hip
bone density.
Screening
lipid levels in a 52-year-old
woman and treating her for
an LDL of greater than 160
costs approximately $400,000
per quality-adjusted life
year.
Screening bone
density in a 65-year-old
woman and treating her for a
T-score of -2.5 costs
approximately $25,000-30,000
(depending on medication)
per quality-adjusted life
year, which is considered
cost-effective.
The
National Osteoporosis
Foundation recommends BMD
testing for all women age 65
or older and for
postmenopausal women with a
risk factor for osteoporosis
(those not on hormone
therapy, very slender women,
smokers, those with a family
history of osteoporosis,
those with a history of loss
of periods when younger, men
and women with a history of
frequent corticosteroid
intake, etc.).
Screening is also
recommended for the
approximately 20-25% of men
with lower testosterone
levels (manifested by
diminished energy,
diminished sexual desire,
etc.) as they age past 50 or
60.
The
US Preventive Services Task
Force recommends BMD
measurements for all women
over the age of 60.
Medicare covers bone
density tests for women over
65.
Bone
mineral architecture is
dynamic, always being
re-formed, always breaking
down.
The idea is to build
more than you break down.
Adequate calcium,
some magnesium and trace
minerals, adequate Vitamin
D, adequate protein and
weight-bearing exercise are
necessary to form new bone.
However, if you are
genetically or otherwise
prone to lose excessive
amounts of bone, all the
calcium in the world will
not protect you, and some
other measure (low dose
estrogens, testosterone,
DHEA, a bisphosphonate
medication such as Actonel®,
Fosamax®, or Boniva®, a
Serm such as Evista®) is
necessary to protect you
from this debilitating
disease.
Bone
density testing is a benefit
of Medicare, most PPO
insurances and some HMOs and
may be done at radiology
services and at the private
offices of most certified
clinical bone density
practitioners.
Cost prices range
from approximately $175.00
at our office in Davis to
approximately $400.00 or
more at radiology services.
Peripheral screens
for low-risk individuals
usually run $30-$50.
Michael
Goodman, M.D. is a certified
clinical bone densiometrist
and gynecologist in practice
in Davis, California.
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