DEAR DOCTOR K:
I’m 65, and my doctor says it’s time for me to be screened for osteoporosis. But isn’t this condition painful? Wouldn’t I know it if I had it?
Osteoporosis is a condition in which bones become less dense, weaker and more likely to break. But unless it leads to a broken bone, osteoporosis is not painful.
Osteoporosis is a disease that causes no symptoms for many years — until it suddenly does. And “common sense” leads many people to ask why they should bother to have tests to diagnose it, or treatments to improve it, if it’s not causing any symptoms. The answer is also “common sense”: so that it will never cause you symptoms.
Most people with undiscovered and (therefore) untreated osteoporosis have never had a fracture. That means they’ve had no symptoms related to their weakened bones.
The gold-standard screening test for osteoporosis is “dual energy X-ray absorptiometry” (DEXA). For this procedure, a machine sends X-rays through bones in order to calculate how dense the bones are. The density of bone is determined in large part by the amount of calcium deposited in the bone. The process is quick, taking only five minutes. And it’s simple: You lie on a table while an imager passes over your body. DEXA can measure bone density at the spine, hip, wrist or total body.
The DEXA scan or ultrasound will give you a number called a T-score. This number represents how close you are to average peak bone density in the population at large. T-score results are interpreted as follows:
- If your T-score is minus 1 or greater, your bone density is considered normal.
- If your T-score is between minus 1 and minus 2.5, you have low bone density, known as osteopenia, but not osteoporosis.
- If your T-score is minus 2.5 or less, you have osteoporosis, even if you haven’t yet broken a bone.
Ask your doctor about being screened for osteoporosis if you are:
- a woman age 65 or older or a man age 70 or older;
- a postmenopausal woman under age 65 or a man age 50 to 70 with one or more risk factors for osteoporosis (such as being a smoker or having a family history of osteoporosis);
- a woman or man with a medical condition (such as anorexia, celiac disease or hyperparathyroidism) or taking a medication (such as anticonvulsants, heparin or loop diuretics) that places you at high risk for osteoporotic fractures;
- a woman or man who has taken glucocorticoids for at least two months;
- a woman in menopause who has specific risk factors that increase fracture risk (such as low body weight or a prior fracture);
- a woman or man over age 50 who has fractured a bone or whose bones look thin on standard X-rays.
So, I agree with your doctor. A screening test for osteoporosis is in your best interest — even if nothing hurts now.