Bone Mineral Density Tests Can Wait
Sticks and stones may indeed break the bones of elderly patients who have osteoporosis, and so doctors have been routinely ordering women over the age of 65 to have a bone-mineral density test every two years. The point of the test is to discover a person’s risk for fracture. But new research out of the University of North Carolina at Chapel Hill indicates that those tests may be superfluous for many patients. Based on study results, the researchers suggest that women who have adequate bone density by age 67 don’t need another test for 10 years.
Bone mineral density tests measure the amount of calcium in a specific area of bone using x-rays. The more calcium you have, the more dense the bone and the less chance of fracture (or so the theory goes). The most common type of bone mineral density test, the dual X-ray absorptiometry (DEXA) of the hip and spine, exposes patients to only one-tenth the radiation of a chest x-ray, and so doctors widely tell patients it’s completely safe. That assumes, of course, that exposure to any radiation is safe, and that little tidbits of hurtful exposure can’t hurt you, especially if you don’t consider the cumulative effects of lots of little doses of exposure over a lifetime. Plus, it ignores the fact that ultrasound also can be used for scanning bones, without any radiation exposure whatsoever.
In any event, Dr. Mary Rhee, assistant professor of medicine at Emory University in Atlanta, says, "DEXA currently is the easiest, most standardized form of bone density testing, so that’s what we use."
The news that scans can be done less often comes as a boon to those who otherwise would have been getting scanned more frequently. Research director Dr. Margaret Gorley said, "Our study found it would take about 16 years for 10 percent of women in the highest bone density ranges to develop osteoporosis. That was longer than we expected, and it’s great news for this group of women."
The findings were based on a control group of 5,035 women aged 67 or older, all of whom had at least two bone density scans during the 15 years of the study. For those women in the group with very low bone density, the scientists recommended annual testing, while those with low density should have the scans every five years, the researchers say.
But here’s the rub (there had to be one). Once the doctor gets the scan results back and realizes the patient has low bone density, he or she is most likely going to prescribe pharmaceuticals. The most common anti-osteoporosis drugs are the bisphosphonates, typically prescribed not just for those with full-blow osteoporosis, but also for patients with low bone-mineral density, and that group includes a huge percentage of women over 65. In 2007, sales of bisphosphonates topped 4.6 billion in the US alone. The next year, more than 37 million prescriptions were written in the US for just one class of bisphosphonate — Fosamax.
What’s the problem with that? As I’ve written at length before, plenty. First of all, the drugs may not be as effective as they are touted to be, because there is no direct connection between bone mineral density and the risk of fracture. For example, according to a study cited on Medicinet.com, "…the improvement in BMD only accounted for 4% of the reduction in spine fracture risk with, 16% of the reduction in spine fracture risk with alendronate [Fosamax], and 18% of the reduction in spine fracture risk with risedronate. Thus, improvement in BMD does not indicate the amount of the anti-fracture benefit of osteoporosis medication." As I’ve pointed out before, these drugs do not encourage growth of new bone; they merely prevent the body from reabsorbing bone (part of the natural bone regeneration process), thus slowing down bone loss while leaving older, damaged bone tissue in place, making it even more vulnerable than before. The bottom line is that although bone density may increase with these drugs, the quality of that bone is far, far less than is found in normal healthy bone…and thus more prone tor fracture.
Then there are the risk factors, and they are woeful. First, there’s a greatly increased risk of jaw death, a horribly painful condition in which the jawbone gets infected and rots away. Then there’s increased risk of abnormal heart rhythm, spontaneous fractures of the thigh bone, and inflammatory eye disease. And finally, there’s the doubling of risk for esophageal cancer. Plus, bisphosphonates seem to increase the number of a type of giant cell known as osteoclasts, and as I’ve written before, nobody seems to know what the long-term implications of that are. In fact, the side effects of bisphoshponates are so severe, that an entire industry has developed in the legal profession based on suing the drug companies for millions of dollars.
Beyond drugs, your doctor may also recommend megadoses of calcium and drinking plenty of milk. But again, as I’ve said at length before, these strategies actually may make matters worse.
The thing is that osteoporosis is a serious disease. Women have a 17-percent chance of suffering a hip fracture in their lifetime, and that’s a significantly higher risk than of developing breast cancer. And 70 percent of those who have hip fractures either become dependent on others for assistance or need long-term care.
Your best bet is to avoid problems by getting plenty of weight-bearing exercise, minimizing your consumption of animal proteins, balancing hormones, supplementing magnesium, and giving up junk foods. A high-acid diet rich in meat, eggs, dairy, cola drinks, and refined foods is the number one contributor to osteoporosis. For more detailed information, check out my report on Osteoporosis.
As for whether or not to get a baseline DEXA scan, that’s up to you. Just remember that if the doctor pulls out a prescription pad after looking at your results, you do have a choice and a voice, and there are alternative ways to rebuild your bones.