steoporosis is often referred to as a “silent disease” because many individuals are unaware they have the condition until a painful fracture occurs. One million fractures a year can be attributed to osteoporosis.Bone Density/ OsteoporosisLinks:

Bone Density
Osteoporosis

BONE DENSITOMETRY (BONE DENSITY TESTING)
Frequently Asked Questions

What is bone densitometry?
Who should have bone density testing?
Who should not have bone density testing?
How is bone mineral density assessed?
How do I go about getting a bone density test?
Is bone density testing safe?
How much does bone density testing cost and will insurance cover it?
How do I prepare for bone density testing?
What should I expect when I arrive for my bone density study?
How do I know if I have osteoporosis from my bone mineral density score?
What is a T-score?
What is a Z-score?
Who should receive therapy for osteoporosis?
Recently I received a bone density screening of my heel. Can I trust the results?
How often should I have a bone density study?
Where can I have my DEXA scan?

 Click here to read an article on Osteoporosis and Young Women

What is bone densitometry?
 prodigyBone densitometry, also called bone density testing, uses dual energy x-ray absorptiometry (DEXA) to determine a patient’s bone mineral density (BMD). DEXA is useful in diagnosing osteoporosis, assessing risk of fracture, and monitoring response to therapy for osteoporosis. Bone densitometry has become widely used because measuring BMD is the only method available for diagnosing osteoporosis in asymptomatic individuals, and it is the best predictor of future risk of fractures. When only routine x-rays are used to assess bone density, bone loss of 30% to 40% must occur before demineralization is detected.

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Who should have bone density testing?
The National Osteoporosis Foundation recommends that women have bone density testing if they are:
Over age 65, regardless of additional risk factors
Postmenopausal and under age 65
– with at least one risk factor besides menopause
– with a fracture
Considering therapy for osteoporosis
On hormone replacement therapy (HRT) for a prolonged period
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Who should not have bone density testing?
Bone density testing is not recommended for individuals who:
Are pregnant
Have had an x-ray with contrast within the last week
Have had a nuclear scan within the last week
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How is bone mineral density assessed?
ap spineAt Diagnostic Imaging Associates the GE Lunar DEXA bone densitometer is used to measure a patient’s BMD. The DEXA scanner is considered the gold standard among health care professionals for measuring bone loss and assessing risk of future fracture. It is a table scanner that uses two energy levels of low-dose x-ray to quickly measure the bone density of several skeletal sites including the wrist, hips, and spine.
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How do I go about getting a bone density test?
During your next physical or doctor’s appointment, ask your physician if you qualify for bone density testing. If you do, you will be given a prescription for a DEXA scan and referred to a local radiology practice that offers this service.
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Is bone density testing safe?
Yes. The procedure is completely noninvasive and exposure to radiation is small, equaling 1/10th of the amount received from a chest x-ray, or the amount of naturally occurring background radiation encountered in one week.
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How much does bone density testing cost and will insurance cover it?
Bone density testing at Diagnostic Imaging Associates costs $275. All third party payers in Delaware offer coverage for bone density testing.
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How do I prepare for bone density testing?
No preparation is necessary for bone density testing. However, it is recommended that you do not take calcium supplements 12 hours before your study.
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What should I expect when I arrive for my bone density study?
dual femurWhen you arrive at any of our offices that offer bone densitometry, you will be greeted by our front desk staff and asked to fill out a patient risk assessment form. After completing this form, you will be taken to a dressing room where you will change into an examination gown. Next, a radiologic technologist will escort you to the bone densitometry room. Your name, age, weight, and ethnicity will be entered into the computer workstation. You will be positioned on the DEXA scanning table and asked to remain still and to breathe normally while the machine scans your bones. A curved plastic arm that emits low-dose x-rays will pass over your body to capture images of the spine, hip, and wrist, which takes approximately 10 minutes.

Once the examination is completed, a computer will compare your bone strength and risk of fracture to the average value for “young normal” adults and the average for your age-matched peers. After the radiologist reviews your report, the results will be sent to your primary care physician who will discuss the findings with you.
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How do I know if I have osteoporosis from my bone mineral density score
The World Health Organization (WHO) has established the following classifications to categorize patients as normal, osteopenic, or osteoporotic based on bone density scores at any skeletal site in white women.

Normal : T-score greater than –1
Osteopenia: T-score between –1 and –2.5
Osteoporosis: T-score below –2.5

Note: The relationship between BMD and fractures in other patient populations such as young women, ethnic minorities, or men has not been established; thus, these WHO classifications are guidelines for all other non-white patients.
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What is a T-score?
BMD values obtained from different skeletal sites (eg, spine and wrist) cannot be directly compared. Instead, these values are discussed in terms of standard deviation (SD). A T-score for BMD is equal to the number of SD above or below the average value for “young normal” adults. For example, if Patient A has a T-score of 1.5, this means she scored 1.5 SD above the average “young normal” adult. If Patient B has a T-score of –2, then she is 2 SD below the average “young normal” adult. For most BMD tests, one SD is equal to 10% to 12% of the average “young normal” adult’s value. In the above examples, Patient A scored 15% to 18% above the average whereas Patient B scored 20% to 24% below the average.
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What is a Z-score?
forearmBMD values can also be expressed as Z-scores, which are also discussed in terms of SD. A Z-score is the number of SD above or below the average BMD value for an age-matched peer (ie, someone the same age as the measured patient). Z-scores are generally not used for discussing a patient’s risk of fracture. Instead, T-scores are preferred because it is when BMD decreases from “young normal” levels that the risk of fracture increases. Abnormalities in BMD are very common in older adults; thus, comparing the patient to persons the same age can be misleading. Z-scores are useful for letting a patient know how s/he compares with someone of the same age.
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Who should receive therapy for osteoporosis?
The National Osteoporosis Foundation recommends treatment for patients who have a:
• T-score less than –1.5 with risk factors for osteoporosis
• T-score less than –2 with no risk factors for osteoporosis
• Fracture and are postmenopausal

In the previous T-score examples, Patient B’s primary care physician may decide to begin therapy for osteoporosis based on her T-score of –2 and whether she has additional risk factors for the disease.
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Recently I received a bone density screening of my heel. Can I trust the results?
lateral vertevral assessment (LVA)Measuring BMD in the heel or forearm by using a portable bone density scanner does not significantly compromise the accuracy of the results, compared with a DEXA table scanner. However, measuring BMD at a single skeletal site is an indicator of osteoporosis only in that part of the body. Osteoporosis does not occur equally throughout the body. A patient in the early stages of the disease may be normal at one site (the heel), but have osteoporosis at another site (the spine). Therefore, relying on the results of a scan of the heel or forearm alone may result in misdiagnosis.

Because portable bone density scanners use ultrasound to assess BMD, the report is more on bone structure than actual BMD. This method has been found to be generally accurate because most individuals with low BMD have also lost bone structure. However, many individuals with low BMD do not have structural loss, and vice versa. Therefore, it is best to use the results from an ultrasound examination as an indicator of whether or not a complete scan of the body should be performed. If you have risk factors for osteoporosis or your results from the portable scanner indicate that you are osteopenic or osteoporotic, it is recommended that you consult your family physician about obtaining a referral for a DEXA scan.
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How often should I have a bone density study?
In general, an appropriate period for follow-up bone densitometry is 1 to 2 years. However, this recommendation truly depends on the specific clinical situation of the patient. Factors such as current medications, risk factors for osteoporosis, fracture history, medical history, surgical history, and the results of prior bone density studies determine the time frame for follow-up examination. It is best to consult with your primary care physician about when a follow-up bone density study would be appropriate for you.
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Where can I have my DEXA scan?
Diagnostic Imaging Associates offers DEXA scanning at three locations— Brandywine, Pike Creek, and Glasgow . To schedule an appointment, contact the location nearest you.
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Osteoporosis
Frequently Asked Questions
What is osteoporosis?
What are the risk factors for osteoporosis?
Do men have to worry about osteoporosis?
How can I prevent osteoporosis?
How much calcium do I need?
Where can I find more information about osteoporosis?

What is osteoporosis?
osteoporosisOsteoporosis is a gradual thinning and weakening of the bones, which can eventually lead to fractures in the hips, vertebrae, and forearms. Throughout life, our bones are in a constant cycle of regeneration called bone remodeling. The bone remodeling cycle is a two-stage process by which bone tissue is dissolved (bone resorption) and then quickly replaced (bone formation). Normally, these two stages occur in close connection. But when resorption occurs at a faster rate than formation, bone density is lost and osteopenia develops. If this imbalance in the bone remodeling cycle continues, osteopenia will progress to osteoporosis, resulting in loss of height, deforming curvature of the spine (dowager’s hump), and back pain.

Osteoporosis is often referred to as a “silent disease” because many individuals are unaware they have the condition until a painful fracture occurs. One million fractures a year can be attributed to osteoporosis. In particular, hip fractures result in as many as 50,000 deaths annually. These deaths usually occur within the first 6 months following fracture. The average cost for hospitalization from a hip fracture is $26,000, not including physician fees.
(The above statistics were obtained from the National Osteoporosis Foundation.)
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What are the risk factors for osteoporosis?
orthopedic hipRisk Factors for Osteoporosis
• Female and older than age 50
• Family history of adult fracture from osteoporosis
• Early menopause (before age 45)
• Amenorrhea for longer than 1 year
• Diet low in calcium
• Low body weight (less than 127 lbs) or small frame
• Inadequate physical activity
• Certain diseases
• Certain medications

It is estimated that 44 million Americans are at risk of developing osteoporosis or low bone mass. Of this group, 30 million are women, 14 million are men, and 55% are persons aged 50 years or older. If this trend continues, an estimated 61 million men and women in the 50 or older age group will have osteoporosis by the year 2020. In 2001, the total cost of treating osteoporosis in the United States was $17 billion.

Women are at greatest risk for developing osteoporosis. After age 35, bone loss tends to begin at a rate of 0.5% to 1% per year because it is more difficult for a woman’s body to efficiently build bone mass. This rate can increase to 3% to 7% annually for the first 3 to 5 years following menopause. One-third to one-half of all postmenopausal women is affected by osteoporosis because estrogen, the hormone that protects against bone loss, is no longer produced by the body after menopause. After age 50, a woman’s risk of developing osteoporosis doubles every 5 years.
(Statistics obtained from the National Osteoporosis Foundation.)
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Do men have to worry about osteoporosis?
Yes. Men of all races and ethnic groups are significantly affected by low bone mass and osteoporosis. New research from the National Osteoporosis Foundation shows that 12 million men are estimated to have low bone mass, and over 2 million are estimated to have osteoporosis. It is expected that by 2010 the prevalence of osteoporosis in men will total almost 3 million and the prevalence of low bone mass will total 14 million.
(Statistics obtained from the National Osteoporosis Foundation.)
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How can I prevent osteoporosis?
The great news is that osteoporosis is preventable in most people. The best defense against osteoporosis is to build strong bones before age 30 and to continue a healthy lifestyle to maintain bone strength throughout life. Prevention is the key because there is no cure for osteoporosis at this time, only treatment to prevent further bone demineralization.

Four Steps to Preventing Osteoporosis:
1) Balanced diet rich in calcium and vitamin D
2) Weight-bearing exercise (walking counts!)
3) A healthy lifestyle excluding smoking and excessive alcohol consumption
4) Bone density testing and medications when appropriate to increase the rate of bone tissue formation
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How much calcium do I need?
total body/body compositionNational nutrition surveys show that many women and adolescent girls are not getting the calcium they need to grow and maintain strong bones. Appropriate calcium intake is essential because the body cannot produce this mineral itself. Calcium is lost daily through normal shedding of the skin, nails, and hair as well as through sweat, urine, and feces. In addition, calcium is necessary for the regulation of the heartbeat, conduction of nerve impulses, hormone secretion, and blood clotting. When the body does not have enough calcium for these processes, it is taken from the bones.

In general, the recommended amount of daily calcium is between 1000 and 1300 mg. Foods rich in calcium include milk, cheese, yogurt, greens, broccoli, dried beans and peas, sardines, canned salmon with bones, and tofu as well as calcium-fortified juices. Although most experts recommend that you receive calcium from natural food sources, supplements can be an essential tool in making up for the calcium lacking in your diet. For a full description of how to select a calcium supplement, visit http://www.nof.org/prevention/calcium2.htm.

Even though a deficiency in calcium is thought to contribute to the development of osteoporosis, it is important to realize that calcium intake is only part of the equation. All four of the above prevention tips are essential to avoid osteoporosis.
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Where can I find more information about osteoporosis?
The leading source of information about osteoporosis is the National Osteoporosis Foundation. You can visit their Web site at http://www.nof.org.
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