Myths about bone density tests and your real risk for osteoporosis

Stay healthy, right down to your bones


here are just two problems with the way women older than 50 deal with thinning bones. The first is that many get treatment they don't need, raising the risk of unpleasant or dangerous side effects from potent drugs. The second? Women who do need help often miss out entirely — and dramatically increase their odds of a catastrophic hip fracture.

It's the worst of both worlds, but it doesn't have to be that way
Here, four bone myths — and the truths that can keep you standing tall.

Myth: I need a bone density test at menopause

Most women should wait until age 65 to get a bone test that gauges their risk of Osteoporosis,a disease in which bones become so porous they can break with little provocation. The 10- to 30-minute procedure uses an X-ray machine, known as DXA, that exposes you to a very low level of radiation.
However, you should ask your doctor about getting tested earlier if you have a family history of the disease, have broken a bone as an adult, are Caucasian or Asian, have a small frame, take certain medications, or have a condition that increases risk, such as inflammatory bowel disease or multiple sclerosis.

Myth: I'm past 65 but don't have to worry — my doctor hasn't suggested a bone density test

Shockingly, only a fraction of women 65 and older are offered the test by their physician, says Watts, even though this age group is at heightened risk of osteoporosis. "Medicare reimbursements for the DXA test have declined by 40 percent since 2006. The procedure now costs doctors more than they are paid, so they don't push it," he says. Legislation to boost reimbursement has been introduced, but so far it hasn't passed

Myth: If I have "pre-osteoporosis," I should start taking drugs

For years, doctors didn't know what to do with patients diagnosed with osteopenia, a condition in which bone mineral density is lower than normal but not yet in osteoporosis territory. "Some doctors started these women on drugs; others didn't," says Watts. "There were no clear guidelines."

Why that matters: Commonly prescribed drugs called bisphosphonates can cause side effects, including flulike symptoms and difficulty swallowing. In very rare cases, patients have developed severe joint or muscle aches months or years after starting treatment.

But this year, the World Health Organization unveiled a risk assessment calculator, called FRAX, that goes beyond bone density to consider 11 other crucial factors in bone health, such as family history or taking skeleton-sapping medications. "It gives a much better sense of a woman's true risk of getting a fracture, and it provides guidance about who needs treatment — and when," says Watts. The National Osteoporosis Foundation recommends medication for postmenopausal women if they have osteopenia and their FRAX shows a 10-year fracture risk above 20 percent. Ask your doctor to calculate your FRAX score.

Myth: I'm too old to build bone

You've probably heard that your skeleton was built mostly in adolescence and young adulthood, and that the lack of estrogen after menopause greatly accelerates bones' decline. But making healthy lifestyle choices when you're older can still have a positive impact on your skeleton, says Felicia Cosman, MD, clinical director of NOF. "Even small gains add up over time," she adds. According to research from Tufts University, postmenopausal women who did strength-training twice a week for a year gained 1 percent to 2 percent in bone density. Any weight-bearing workout can provide similar benefits. The key: Keep increasing the intensity.
Although food can't build bone density, the right diet can drastically slow your rate of loss. Be sure to include calcium-rich choices in yours

By Meryl Davids Landau
Prevention Magazine
Copyright© 2009 Rodale Inc.