Ask An Expert: Bone Density Test

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Ask An Expert: Bone Density Test

Question:

My gynecologist wants me to have a bone density test done every two years. Is this really necessary?

Answer:

A bone mineral density (BMD) test is usually ordered to screen for osteoporosis, a condition marked by low bone density and an increased risk of fracture. Osteoporosis-related fractures, especially those involving the hip or spine, may cause significant pain, require major surgery and may lead to loss of mobility, loss of independence and even death. That's why early detection and treatment are so important.

However, when it comes to screening for osteoporosis, physicians' opinions and practices vary widely. The National Osteoporosis Foundation recommends widespread BMD testing, including screening all women aged 65 and older, those with risk factors for osteoporosis (other than being white, postmenopausal and female), those with fractures, or to monitor response to osteoporosis treatment. There is also no clear consensus regarding how often to repeat BMD testing; the two-year interval is a common one, perhaps because that's how frequently many medical insurance plans will cover the cost of the test.

Earlier and more frequent testing may be recommended if you already have osteoporosis or if you have risk factors for the disease, including advanced age, smoking, low body weight, use of corticosteroids, or family history of osteoporosis.

It may be acceptable to repeat BMD testing less frequently than every two years, but that depends on a number of factors, including:

• Whether you have had prior fractures related to osteoporosis — If you have, more frequent testing could detect falling BMD in time to change treatment and prevent another fracture.

• The results of your past BMD tests, particularly the trend over time — If it has been repeatedly normal, less frequent testing might be acceptable.

• Whether you have risk factors for osteoporosis — Fewer risk factors could make less frequent screening more appropriate.

• Whether testing would alter treatment — If you and or your doctor decide that the results of testing would not affect treatment, it may make little sense to repeat it every two years. For example, I have patients who are already taking extra calcium and vitamin D but are unwilling to take other treatments to prevent or treat osteoporosis regardless of their BMD results; for these patients, repeated BMD testing is probably not helpful.

Talk to your doctors about your particular risks for osteoporosis, the results of past BMD testing, and how repeated testing is likely to affect your care. Together, you can decide on a medically appropriate and acceptable screening schedule.

Robert Shmerling, M.D., is associate physician and clinical chief of rheumatology at Beth Israel Deaconess Medical Center and an associate professor in medicine at Harvard Medical School. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program and has been a practicing rheumatologist for over 25 years.

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Last updated:	January 24, 2007