Osteoporosis Screening and Diagnosis
Diagnosing osteoporosis before a fracture occurs is far preferable to waiting for a fracture to occur. Osteoporosis can be easily diagnosed by a DXA (dual energy X-ray absorptiometry, also called bone mineral density) test, a simple 10-minute test using tiny amounts of radiation. The DXA is the best way to assess bone health and diagnose osteoporosis.
People who should have a DXA include women and men who:
- Have had a fracture following mild trauma (eg. slip and fall)
- Have low estrogen (women) or testosterone (men) levels
- Are on prednisone chronically
- Have chronically overactive thyroid or parathyroid function
- Have elevated blood prolactin levels.
In addition, Dr. Streeten says that all women over 65 and all men over 70 should get a DXA test. She also recommends that all post-menopausal women under age 65 who have other risk factors for fracture should have a DXA.
Those other risk factors include being relatively thin (under 127 lbs for women), having a parent who had a hip fracture or a parent or sibling diagnosed with osteoporosis, having hyperthyroidism, smoking, excessive alcohol intake, and chronic use of prednisone or other medications known to increase the risk of osteoporosis (eg. anti-seizure medicines).
Generally, the DXA is done in pre-menopausal women and men under age 50 only when they are chronically on prednisone, have had a fragility fracture or have a known genetic disorder that increases fracture.
"According to the National Osteoporosis Foundation guidelines, "reasons to treat with an osteoporosis medication are if the DXA T-score (standard deviation away from young normals at peak bone mass) is less than -2.0 and there are no other risk factors for fracture or if the T-score is less than 1.5 and there is another risk factor for fracture," says Streeten.
A DXA test can be scheduled by calling the Department of Diagnostic Radiology's outpatient center (located at 419 W. Redwood Street) at 410-328-3225. An order from a doctor is required to get insurance coverage for the test. The DXA is also used to follow osteoporosis patients to determine if they are responding to treatment.