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A FEELING IN THE BONES

Preventive bone density testing can help monitor the onset of osteoporosis.

by Sonia Javelosa-Silos, M.D.

OCTOBER 2012

More often than not, people are oblivious about their health until something serious happens to them. It’s a matter of knowing that tests for early detection are available out there—and osteoporosis is one such condition that often goes unnoticed.


Hidden malady

Carlo Sumpaico, M.D., an orthopedic specialist at The Medical City, gives an overview of the disease. “Osteoporosis is a condition characterized by a decreased density of bone which reduces bone strength and thus, increases the risk of bones breaking,” he explains. “People with osteoporosis most often do not know they are affected until they break a bone or their doctor requests for a screening test. Fractures can occur with minor trauma and even during coughing or sneezing,” Dr. Sumpaico adds.

Adults reach their peak bone mass sometime between the third and fourth decades of life. After that, there’s a normal rate of decline in bone density. For women, this is further compounded by the onset of menopause, which adds an extra degree of bone loss. In general, women start off with a lower bone density than men and therefore, postmenopausal women are ultimately more prone to fractures as compared to men of the same age.


DXA scanning: important for health

Periodic measurement of bone density is a recommended part of the 2010 clinical guidelines of the National Osteoporosis Foundation in the U.S. Bone density may be detected using a dual-energy X-ray absorptiometry test, or DXA scan. “This should not be confused with the bone scan, which is a nuclear medicine test using an injected radioactive tracer. The bone scan test is used to detect tumors, fractures, and infections in the bone,” Dr. Sumpaico emphasizes. “The DXA scan, on the other hand, is a simple X-ray test that measures bone density, the results of which are used to predict the risk of fractures.”

The DXA scan is easy to perform and requires only a low amount of radiation exposure, much less than that of a standard chest X-ray. It’s painless, quick and non-invasive, and recommended for all women aged 65 and above and men over 70—the age groups wherein osteoporosis is most likely to develop. For postmenopausal women between 50 to 65 years old, or men in the 50 to 70 age group, DXA scanning is indicated with any of the following:

• history of a fracture as an adult;

• physical inactivity;

• chronic illness;

• prior use of corticosteroid medications for more than three months;

• significant loss in height of at least four centimeter, which may indicate a compression fracture in the spine;

• transplant recipients;

• reduced levels of hormones due to either early menopause or cancer treatments for breast or prostate cancer;

• alcohol intake of three or more drinks per day;

• current smoker;

• strong family history of osteoporosis; or

• increased risk of falling—such as those with dementia, poor vision, or impaired mobility.


There are two types of DXA scanning available. The central DXA measures bone density at the lower spine and hip, while the peripheral DXA measures the heel, wrist, shin bone or kneecap. “At present, it is the central DXA scan which is the more accurate and reliable test and is the gold standard for diagnosing osteoporosis. Peripheral DXA scanners are smaller in size, portable, and can be used in the doctor’s clinic. However, their use is limited as a screening tool to identify persons who require further testing,” Dr. Sumpaico explains.


The lowdown on low bone density

DXA scan results are reported as T-scores and Z-scores. The T-score is a measure of your bone density, compared to that of a normal healthy 30-year old adult of your sex. The World Health Organization developed definitions for osteoporosis and osteopenia, or low bone density, based on T-scores.

Normal: T-score between 0 and -1

Osteopenia: -1 to -2.5

Osteoporosis: less than -2.5


Z-scores measure the subject’s bone density as compared to other people of the same age, sex, weight, height and race. A Z-score of -2 or lower can indicate that aging may not be the only cause of abnormal bone loss—suggesting another underlying condition.

“For both T- and Z-scores, a negative value indicates that you have thinner bones than normal. Subsequently, the more negative the value, the higher the risk for fractures,” Dr. Sumpaico emphasizes.


To find out more about what you can do to keep osteoporosis at bay, grab a copy of the October issue of HealthToday, out now in newsstands and bookstores.























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