After determining a patient’s risk factors, the second step in preventing osteoporosis and associated spine fractures is to get an assessment of bone mass. A bone density test (also termed "bone mineral density test" or "BMD test") is the gold standard diagnostic procedure used to detect osteoporosis. The test measures bone mass, usually in the hip and lumbar spine, quickly and painlessly.
According to the National Osteoporosis Foundation and the U.S. Preventive Service Task Force, a bone density test is recommended in the following situations:
- All women over age 65
- Postmenopausal women under age 65 who have multiple risk factors
- At menopause, if undecided about hormone replacement therapy
- Abnormal spine X-rays
- Long-term oral steroid use
- Hyperparathyroidism (over-active parathyroid gland)
The established standard for measuring bone density is the dual energy X-ray absorption scan (termed a DEXA scan or DXA scan). The test is performed by passing low energy X-rays through a bone, most often of the lower spine and hips. The DEXA scan results will indicate whether a person has normal bone density, low bone mass, or osteoporosis. This particular bone density test is the only one that can be used to diagnose osteoporosis and track bone density changes over time.1
While bone mass density testing involves a low level of radiation exposure, most medical professionals agree this risk is low (e.g., just a fraction of the exposure in a chest X-ray) compared with the benefits of identifying osteoporosis before a fracture occurs.
Patients are advised to decide with their physician whether or not to have a DEXA bone density test. Given the criticality of early diagnosis and prevention of osteoporosis to avoid a fracture, patients who believe they are at risk for osteoporosis are encouraged to proactively bring up the topic of bone density testing to discuss with their treating physician.
Medicare usually covers the cost of a DEXA scan to screen for bone density for the following groups of individuals:
- Women over 65 years of age
- Women less than 65 who have significant risk factors for osteoporosis
- Men who have significant risk factors for osteoporosis.
Medicare may cover follow-up tests every 2 years for certain individuals. Private insurance companies vary in their coverage of DEXA scans, and many will cover screening DEXA scans provided that the patient has several osteoporosis risk factors. As of 2006, the cost of a DEXA scan typically ranges from about $125-$350.
A combination of results of the DEXA bone density test, a thorough history and physical exam, and any other necessary examinations and diagnostic tests, will provide the facts to accurately diagnose both:
- The presence of osteopenia (loss of bone density, a precursor to osteoporosis) or osteoporosis, and;
- Whether osteoporosis is a primary problem or secondary to another problem (e.g., long-term use of oral steroids). This distinction is important because the treatments are often different.
Regardless of the stage of osteoporosis, the next step in outsmarting the disease is to develop a personalized treatment plan to slow bone loss and/or rebuild bone density to help avoid an osteoporosis-related fracture of the spine or other bones.