Screening Tests for Osteoporosis

Osteoporosis describes a decrease in bone mass. It causes dense bones to become thin and porous. Having thin bones increases your risk for developing a fracture (broken bone). Approximately 10 million people in the United States have osteoporosis, and 18 million more have early thinning of bones that puts them at increased risk of developing osteoporosis. However, only 23% of people who have osteoporosis know that they have it or have talked with their doctor about their condition. Special bone density tests are available to help your doctor find out if you have osteoporosis and to what degree osteoporosis has affected your bones. Using the information from the test, your doctor can prescribe a treatment plan to help strengthen your bones.

Who needs a bone density test?
All women who are 65 years of age or older should have a bone density screening test. Women should have a screening test at an earlier age if they have a family history of osteoporosis, have an increased incidence of fracture after the age of 45, currently are smoking, are underweight, or have other risk factors discussed in "Osteoporosis: Am I at Risk?" (p. 1). In addition, women or men who are considering therapy for osteoporosis should be screened. If a person has a disease or is taking any medication that can cause bone loss, he or she should have a screening test. Women who have been on hormone replacement therapy for a prolonged time also need to be screened.

Types of screening tests
Several tests are available to screen bones for osteoporosis. The most widely used and most accurate test is called a DEXA (dual-energy x-ray absorptiometry) scan. The DEXA scan can measure the bone density in your spine (back bone), hip, or whole body. It is painless and takes about 15 minutes to complete. Some blood tests also are available, but they mainly are used to determine how effective treatment is.What do the results mean?The DEXA scan can give three basic results: 1) a normal scan, 2) osteopenia (early thinning of bones), or 3) osteoporosis. Your need for further evaluation and treatment is based on the amount of bone loss that this scan shows.Will Medicare cover the cost?Currently, Medicare covers the cost of one DEXA scan every two years for specific diagnoses, which include the following:

1. Your doctor or other qualified medical professional determines that you are estrogen deficient (i.e., postmenopausal) and at risk for developing osteoporosis based on your medical history and other findings.
2. X-rays show abnormalities of your vertebrae (spine bones) that indicate osteoporosis, osteopenia, or fracture.
3. You are receiving or expecting to receive steroid therapy consisting of 7.5 mg or more of prednisone each day for more than three months. (Steroids are medications given to treat various diseases, such as arthritis, asthma, Crohn disease, and lupus.)
4. You have primary hyperparathyroidism (overactive parathyroid).
5. You are being monitored to assess how well your bones are responding to a United States Food and Drug Administration-approved osteoporosis drug therapy, such as estrogen, alendronate (Fosamax), or calcitonin.

In certain cases, Medicare will cover the cost of having a DEXA scan more often than every two years. Your doctor can tell you if Medicare considers you eligible for more frequent testing.

Osteoporosis can be a debilitating problem for women and men. By using special tests, such as the DEXA scan, your doctor can diagnose the degree of bone loss and can formulate a treatment program to strengthen your bones and help you remain active.

Kristyn Fagerberg, M.D.
Columbus, Georgia