Physicians Using Bone Density Testing In The Diagnosis Of Osteoporosis

Adrian Parker (left), bone density technician, lines up DEXA equipment to perform a bone density scan on a patient.

An estimated 28 million Americans are at risk of having osteoporosis, and 80 percent of them are women. Fortunately today’s technology is allowing physicians like Dr. Howard Nankin to identify and treat osteoporosis earlier in women before the disease progresses to such complications as a disfiguring dowager’s hump or a hip fracture that can dramatically impact mortality.

A professor in the Department of Internal Medicine, Dr. Nankin can evaluate the health of a patient’s bones through bone mineral density testing available in his department. Using dual energy x-ray absorptiometry (DEXA) equipment, he and other physicians determine if osteoporosis has resulted in mineral loss and reduced bone strength in a patient.

“The beauty of DEXA is that we can quantify quite precisely how much mineral is in the bone,” said Dr. Nankin. “We can see changes well before they would show up on conventional x-rays.” The spine, hips and wrists, which are the sites most commonly fractured, are studied in the simple, painless procedure. “The spine in particular has mainly spongy bone, which is more vulnerable to losing minerals,” he said. The test results provide physicians with invaluable diagnostic information. “We can use bone density testing to tell the patient how they compare with what is considered to be normal bone density, what their risks are for fracturing bones, and what they can expect over time,” said Dr. Nankin.

If significant mineral loss is detected through DEXA, physicians can choose from several drug therapy options that slow down the rate at which the patient loses bone. A new class of treatment, expected to receive FDA approval in the next few months, will be the first osteoporosis medication that actually stimulates new bone formation. Additional DEXA testing can be used with a patient in the future to monitor the effectiveness of treatment in stabilizing bone loss.

“People ask why we are seeing so much osteoporosis now, and there’s no pat answer,” Dr. Nankin said. Physicians and researchers speculate on factors such as a population that’s living longer, less physical activity on a regular basis, and an increased likelihood of inadequate calcium intake during the years when it’s most crucial. “We drink a lot of soft drinks and not enough milk, especially teenagers. Teens need to absorb huge amounts of calcium to build their bone mass,” he said, noting that an individual’s peak bone mass occurs between 25 and 30 years of age.

Dr. Nankin stressed that it’s prudent for women to take a proactive approach to osteoporosis. Because accelerated mineral loss is associated with menopause, he recommends that women have a bone density test as they are approaching menopause, even if they have none of the risk factors associated with osteoporosis. “The only way to know if you have osteoporosis is by having a bone density test. Once you get the disease, it is much more difficult to treat it than it is to prevent it,” he said.

Reprinted from Connections newsletter, September 2003

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