A bone-density test is a way to measure the strength of your bones. The test, called a DEXA scan, is a kind of X-ray.
Many people get a bone-density test every few years. The main reason to have the test is to find and treat serious bone loss. But most men, and women under age 65, probably don’t need the test. Here’s why:
Most people do not have serious bone loss.
Most people have no bone loss or have mild bone loss (called osteopenia). Their risk of breaking a bone is low. They do not need the test. They should exercise regularly and get plenty of calcium and vitamin D. This is the best way to prevent bone loss.
The bone scan has risks.
A bone-density test gives out a small amount of radiation. But the harmful effects of radiation can add up, so it is best to avoid it when you can.
The drugs used to treat bone loss have risks.
The most common drugs to treat bone loss are Fosamax (generic alendronate), Boniva (generic ibandronate), and Actonel (generic risendronate).
These drugs have many risks and are over-prescribed. Common side effects include upset stomach, difficulty swallowing, and heartburn. Rare side effects include bone, eye, joint, and muscle pain, cracks in the femur (thighbone), bone loss in the jaw, and heart rhythm problems.
Other drugs used to treat bone loss also have risks, including blood clots, heart attacks, strokes, and serious infections.
The treatments have limited benefits.
Many people are given drugs because they have mild bone loss. But, there is little evidence that these drugs help them.
And, even if the drugs do help, they may only help for a few years. So, you may want to consider them only if you have serious bone loss. Serious bone loss is called osteoporosis.
The test can be a waste of money.
A DEXA scan costs about $125. And if your doctor prescribes a drug when you only have mild bone loss, you spend money you don’t need to. A month’s supply of generic alendronate can cost as much as $75. Fosamax, the brand-name of the same drug, can cost twice as much.
Who should get a bone scan?
Women should get a bone scan at age 65. Men age 70 and up may want to talk with their doctors about the risks and benefits before deciding. Younger women, and men ages 50 to 69, should consider the test if they have risk factors for serious bone loss. Risk factors include:
- Breaking a bone in a minor accident.
- Having rheumatoid arthritis.
- Having a parent who broke a hip.
- Drinking heavily.
- Having a low body weight.
- Using corticosteroid drugs for three months or more.
- Having a very low vitamin D level.
You may need a follow-up bone-density test after several years. That depends on the results of your first test.
This report is for you to use when talking with your health-care provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.
© 2016 Consumer Reports. Developed in cooperation with the American Academy of Family Physicians.
- Bone Density Tests: When you need them and when you don’t
- Getting an Early DEXA Bone Density Scan
- Bone Densitometry
- How will bone mineral density be measured for patients aged 70 years or over?
- What about patients diagnosed with osteoporosis?
- Are Medicare recommended fees and benefits changing?
- Questions and Answers
Bone Density Tests: When you need them and when you don’t
A bone-density test is a way to measure the strength of your bones. The test, called a DEXA scan, is a kind of X-ray. Many people get a bone-density test every few years. The main reason to have the test is to find and treat serious bone loss, called osteoporosis, and prevent fractures and disability.
Most men under 70 and women under age 65 probably don’t need the test because:
Most people do not have serious bone loss.
Most people have no bone loss or have mild bone loss (called osteopenia). Their risk of breaking a bone is low so they do not need the test. They should exercise regularly and get plenty of calcium and vitamin D. This is the best way to prevent bone loss.
The bone-density scan has risks.
A bone-density test gives out a small amount of radiation, but radiation exposure can add up. The effects can add up in your body over your life, so it is best to avoid it if you can.
Who should get a bone-density scan?
For women over 65 and men over 70, DEXA scans are only appropriate for those with moderate risk of fracture or when the results will change the patients care plan. Younger women and men ages 50 to 69 should consider the test if they have risk factors for serious bone loss. Risk factors include:
Younger women and men ages 50 to 69 should consider the test if they have risk factors for serious bone loss. Risk factors include:
- Breaking a bone in a minor accident.
- Having rheumatoid arthritis.
- Having a parent who broke a hip.
- Drinking heavily.
- Having a low body weight.
- Using corticosteroid drugs for three months or more.
- Having a disorders associated with osteoporosis.
You may need a follow-up bone-density test after several years, depending on the results of your first test.
If you do have bone loss, you may be offered drug treatments.
The most common drugs to treat bone loss are Fosamax (generic alendronate) and Actonel (generic risedronate). These drugs have benefits and risks to think about and discuss with your health care provider. Common side effects include upset stomach, difficulty swallowing, and heartburn. Rare side effects include bone, joint and muscle pain, cracks in the thighbones, bone loss in the jaw, and heart rhythm problems. Other drugs used to treat bone loss also have risks, including blood clots, heart attacks, strokes, and serious infections. The treatments have limited benefits in some patients. Many people are given drugs because they have mild bone loss, but there is little evidence that these drugs help them. Even if the drugs do help, they may only help for a few years, so you may want to consider them only if you have serious bone loss. Mild bone loss is better treated with exercise, vitamin D and calcium.
How can you keep your bones strong?
The following steps can help you build bone:
Exercise. The best exercise for your bones is exercise that makes your bones carry weight. When you walk, your bones carry the weight of your whole body. You can also lift weights. Aim for at least 30 minutes of weight-bearing exercise a day.
Get enough calcium and vitamin D. They help keep your bones strong.
- Aim for at least 1,200 mg of calcium a day. Eat foods high in calcium, such as dairy products, leafy green vegetables, and canned sardines and salmon. You may need a calcium pill each day.
- Consider taking vitamin D if you are a woman in menopause or you get little sun. Take 800 IU a day.
Avoid smoking and limit alcohol. Among other things, smoking and drinking alcohol can speed up bone loss.
- Try a stop-smoking program. Ask your health care provider about a nicotine patch or other treatments.
- Limit yourself to one drink a day for women, and two drinks a day for men, unless you have medical reasons for tighter limits.
Try to avoid certain drugs. Some drugs can damage bones. These include proton pump inhibitors (common ones are omeprazole, lansoprazole, and pantoprazole), used to treat heartburn; corticosteroids; and some of the newer antidepressants. If you take one of these drugs, ask your health care provider about whether these medications are right for you.
Getting an Early DEXA Bone Density Scan
Everyone loses bone mass as they get older, but only some people will develop osteoporosis, a serious condition in which excessive bone loss causes bones to fracture easily.
Because osteoporosis and its precursor, osteopenia, have no symptoms, the only way to know the state of your bone health is a test of bone density such as the DEXA bone density scan. The United States Preventive Services Task Force recommends bone density scans for everyone over age 65. But should you have the test earlier so you can take steps to keep your bones strong?
DEXA Bone Density Scan: Assessing Bone Health
It’s called the dual-energy X-ray absorptiometry scan, but DEXA (or DXA) rolls off the tongue a bit easier. The DEXA bone density scan uses advanced X-ray technology to examine bones, determining how dense they are and how much bone mass has been lost. There are several tests and methods that can be used to diagnose bone loss, but the DEXA bone density scan is considered the gold standard.
DEXA Bone Density Scan: Coming of Age
A DEXA bone density scan is generally recommended for people over age 65 and those who have risk factors for osteoporosis. The scan can tell you the status of your bone health and help your doctor determine what steps you need to take should the results indicate bone loss and osteoporosis risk.
“As a general rule, women over age 65 should receive a DEXA bone density scan,” says Chad Deal, MD, head of the Center for Osteoporosis and Metabolic Bone Disease at the Cleveland Clinic in Ohio. “Postmenopausal women up to age 65 should be scanned if they have risk factors present — this is interpreted broadly and can include family history, low body weight, smoking, three alcoholic drinks per day, and previous fracture, or the use of steroids.”
Whatever your age, if you’re concerned about your bone health, you can request a DEXA bone density scan from your doctor.
DEXA Bone Density Scan: Weighing the Benefits
Any time that X-ray equipment is used, it’s important to consider the potential benefits and risks of radiation exposure. Though there is some radiation from a DEXA scan, the amount is less than one-tenth the dose of a standard chest X-ray and less than the amount of natural radiation you are exposed to in a day.
Dr. Deal says there are essentially no risks associated with having a DEXA bone density scan. On the other hand, there are some significant benefits:
- DEXA test results are extremely accurate in diagnosing bone loss and evaluating the risk of osteoporosis and fracture.
- The test has no side effects.
- The test is painless, relatively fast, and requires no anesthesia.
You should talk to your doctor about whether it makes sense for you to have a DEXA bone density scan in view of your osteoporosis risk. Getting a DEXA scan before age 65 can give you peace of mind if it shows your bones are healthy. If the test detects bone loss, you can take action to help keep it from progressing.
“The benefits are early identification of fracture risk and prevention of future fractures,” says Deal. The question becomes whether your insurance will pay for the test.
DEXA Bone Density Scan: Footing the Bill
While the DEXA test is painless, the cost may not be — not every insurance plan will cover all types of diagnostic scanning tests.
“Many insurance companies will not cover a patient who is under 65 without risk factors,” says Deal.
Before you have the test, check with your insurer to determine whether the test will be covered and under what circumstances. If you decide to pay for the test out-of-pocket; the cost could run anywhere from $125 to more than $300, depending on the facility.
Keep in mind that even if you feel fine and don’t have any symptoms, your bones could still be thinning significantly. Because of this risk, finding out where you stand on bone density might be a good, preventive idea. Based on your personal risk factors and concern about osteoporosis, you and your doctor can decide if a DEXA bone density scan is right for you.
What is a DEXA scan?
By Deborah Condon
One in three women over the age of 50 will be affected by osteoporosis, according to the Irish Osteoporosis Society (IOS). However a simple scan that takes just 10 to 15 minutes, can predict the risk of fracture and help to identify patients who would benefit from taking preventative measures or treatment.
Osteoporosis is a condition in which there is a thinning of the bones, causing them to fracture (break) more easily. It is most commonly associated with older women, although men and younger people can also develop it. The DEXA (dual energy X-ray absorptiometry) scan provides a direct measurement of bone density. It is currently the most accurate and reliable means of assessing the strength of your bones and your risk of breaking a bone.
The scan is fast, accurate and painless and the dose of radiation used is extremely low. So what happens when you go for a scan, how much does it cost and who exactly needs to consider having one?
A DEXA scan takes just 10 – 15 minutes
Anyone, male or female, who displays one or more of the risk factors for osteoporosis, irrespective of age, should have a DEXA scan. This is because the earlier osteoporosis is identified, the more can be done to prevent it progressing. As a result, women in their 30s should consider having a scan, for comparison purposes in later years.
“Unlike their mothers, women today can take positive action to prevent the onset of osteoporosis or future bone fracture and can benefit from diagnosis and treatment. Today’s treatments can help to prevent bone fracture by increasing bone density or slowing down and stopping bone loss”, according to Dr Darragh Foley-Nolan, a consultant in rheumatology at Waterford Regional Hospital.
Specific risk factors for osteoporosis in women include a lack of oestrogen caused by, for example, an early menopause (before the age of 45) or an early hysterectomy (also before the age of 45). In men, having low levels of the make hormone, testosterone, is a risk factor.
However there are also a number of other risk factors for both women and men, including:
-Long-term use of high dose corticosteroid tablets, for conditions such as asthma and arthritis.
-A close family history of the disease, i.e. if your mother or father had it.
DEXA scans are usually carried out in a hospital, however some private clinics and GP surgeries also have scanners. When you are brought in for your scan, the scan technician will weigh you and measure your height. You will then be asked to lie on a padded examination table. You will remain fully clothed for the scan, only taking off your shoes. You will be asked to lie completely still while the scanner moves over the area of your body that is being scanned – most often the lower spine and hips.
Prior to the scan, you must inform the technician if you are pregnant (or think there is a chance that you are pregnant), if you have a metal implant in an area that may be scanned or if you have had any fractures in the past. You should also alert the technician if this is not your first scan, to allow your results to be compared.
The results of the scan will be made available immediately or very soon after, depending on where you have the it done. Your scan results will be given in the form of a T-score. This is where your results are compared to peak bone mass, which is the normal bone density found in healthy people aged between 23 and 35.
Your scan results will also be compared to the bone density of people of your own age (the Z-score), however osteoporosis will be clinically diagnosed based on your T-score.
A T-score value greater than -1 shows that your bone density level is normal and you do not have osteoporosis. A T-score value of between -1 and -2.5 indicates that you have osteopenia. This is the early stage of osteoporosis and is a warning that you must start taking care of your bones.
A T-score of below -2.5 meanwhile indicates osteoporosis. If you are found to have either osteoporosis or osteopenia, your doctor will make a number of recommendations, which may include medication and lifestyle changes such as quitting smoking, calcium and vitamin D supplements, a weight bearing exercise routine and reduced amounts of caffeinated drinks. You will also be asked to undergo a follow-up DEXA scan within 18 – 24 months, to assess any changes in bone health.
The Irish Osteoporosis Society recommends that you are scanned every two years after your initial scan. It also advises people to attend the same hospital for each scan if this is possible. This is because there are 10 different types of DEXA scanner and each one produces results in a different way, therefore for comparison purposes, it is more straightforward if you are rescanned by the same machine.
A DEXA scans costs between €80 and €100. If you are already a patient of a consultant and have a medical card, you may be able to avail of the scan free of charge, however the IOS warns that you may face a waiting list of up to a year for this.
“We recommend that people pay for this privately if at all possible. It is not a huge sum and the scan is so important”, a spokesperson told irishhealth.com.
If you do pay privately, you can claim back tax relief for medical expenses. (You will require a Med 1 form from the Irish Revenue Commissioners.)
You may be able to claim some of the expenses back if you have private health insurance. Those with BUPA insurance can apply the cost of their scan to their annual excess.
Members of the VHI’s Healthsteps schemes can also claim back part or all of the cost of the scan. However bone density scans are not covered under any of the VHI’s hospital plans.
With VIVAS Health, a DEXA scan is categorised as ‘health screening’ – under its day to day plan, you can claim back €50 for one screening per year, i.e. if you claim for a different type of screening in one calendar year, you will not be able to claim back anything on your DEXA scan.
If you have private health insurance, check your membership booklet for details.
The Irish Osteoporosis Society can be contacted at (01) 677 4267 or [email protected]
Discussions on this topic are now closed.
t-scores. Item 12320 continues to make available an initial bone densitometry service for those patients aged 70 years or over who have not already had this service; and
From 1 November 2017, the MBS bone densitometry items with the changes outlined above, will be included in the Health (General Medical Services) Table Regulation 2017 in conjunction with their removal from the Health Insurance (Bone Densitometry) Determination 2012.
How will bone mineral density be measured for patients aged 70 years or over?
From 1 November 2017 there will be two new MBS items for patients aged 70 years or over.
Patients 70 years or over will continue to be eligible for an initial screening study (item 12320).
Patients with a bone mineral density t-score of -1.5 or above will be eligible for one scan every 5 years (item 12320).
Patients with a bone mineral density t-score of less than -1.5 and above -2.5 will be eligible for one scan every two years (item 12322).
The Taskforce considers these testing frequencies to be clinically appropriate. A testing interval of one year is not considered reliable in detecting change attributable to actual bone loss in the screening setting.
What about patients diagnosed with osteoporosis?
Patients diagnosed with osteoporosis will continue to be able to use the existing clinically appropriate bone densitometry MBS items. The Taskforce did not recommend changes to eligibility and time restrictions for these items.
Are Medicare recommended fees and benefits changing?
There are no changes to the MBS recommended fees and benefits as part of the Taskforce recommendations. The MBS schedule fees and benefits for the two new items, 12320 & 12322, will be the same as the item they replace (12323).
It remains the case that medical and health practitioners, including diagnostic imaging providers, are free to set their own fees for the services they provide and to determine their own billing practices. Consumers are responsible for any difference between the applicable Medicare benefit and the fee set by the provider. Where a provider chooses to bulk bill there should be no out-of-pocket cost.
Questions and Answers
A Fact Sheet summarising the MBS Bone Densitometry changes is available at www.mbsonline.gov.au
The official announcement regarding the Bone Densitometry changes is available on the webpage Reducing unnecessary bone densitometry testing.
I have a writer’s body: soft, pale, and devoid of muscle tone. I’ve never done a proper pushup in my entire life. Hell, I couldn’t even use the monkey bars when I was a kid. (Did I consistently fail the Presidential Physical Fitness Test? What do you think, buddy.)
In spite of the fact that, when unclothed, my body resembles a sack of tapioca pudding held upright by bones, I am not overweight— or, more accurately, I can pass as a slim person. While “slim” decidedly does not mean “healthy,” in the past I never had to confront the awful truth of how much fat I have compared to muscle, or how much bone is in my, uh, bones. I didn’t have to know what this passable flesh sack was made of. Finding out was prohibitively, mercifully expensive. Now, thanks to DEXA scans, all it takes to get to the bottom of one’s bottom is $45 — no physician and no insurance required.
DEXA stands for Dual Energy X-Ray Absorptiometry. Its original purpose is to measure bone density, but it’s also able to measure one’s entire bodily composition with harrowing accuracy. DEXA scans are the most precise test of such things. Hydrostatic weighing, the use of calipers, and the Bod Pod — which is, I assure you, a real thing — pale in comparison.
“In the past I never had to confront the awful truth of how much fat I have compared to muscle. Finding out was prohibitively, mercifully expensive.”
This accuracy, combined with its low cost, has made it popular among fitness freaks and people looking to document their road to weight loss. I am neither, but I am curious. So I got one. And I got an RMR (Resting Metabolic Rate) test, which measures how many calories your body burns when in repose, just for good measure. The total price for both? A reasonable $120.
I didn’t even have to wait in a doctor’s office; rather, I got these tests in a nondescript loft that had been divided into cubicles. Upon arrival, I filled out an intake form wherein I agreed that the establishment administering my tests would “not provide medical advice and any diagnosis, treatment, operation or prescription for any illness or ailment.”
They, of course, don’t need to provide any diagnoses; clients are more than capable of taking care of that themselves. DEXA scans are the perfect complement to America’s fascination with self-diagnosis. And the popularity of WebMD, fear-mongering bloggers like The Food Babe, and snake oil salesmen like Dr. Oz prove that people are more than willing to take medical advice from basically anyone. As healthcare costs rise, we can only assume this trend will continue.
“DEXA scans are the perfect complement to America’s fascination with self-diagnosis.”
BodySpec, the company that provided my scan, informed me their place of business also offers nutritional coaching, and suggested I come back for another scan to “chart my progress” once I started my “exercise regimen.” Which, to be completely honest, the results of my initial DEXA test made me, the least active person in Los Angeles, want to start. Because, you see, the DEXA test shamed me. The DEXA test broke me. The DEXA test allowed me to diagnose myself as a 115-pound obese woman.
I am 115 pounds, sure, but 43.5 pounds of it — 37.5% of my body — is pure fat. This puts me, according to the distressingly fit middle-aged woman who explained my results, in the 80th percentile for women my age. Which means 80% of all women have less body fat than me. Are you, dear reader, a woman? If so, there is an 80% chance you have less body fat than me. Congratulations.
On the bright side, I am in the 60th percentile for women over 60, which means my body fat percentage is slightly better than most people on the precipice of death. Hurrah! The next fun fact she trotted out was that my Relative Skeletal Muscle Index (RSMI), a measurement of the amount of muscle in my arms and legs, is woefully below average. Apparently, my arms are 40.9% fat. Good to know, I thought, as she explained this to me. And, by “good,” I mean “terrifying.”
“The DEXA test allowed me to diagnose myself as a 115-pound obese woman.”
If you’re wondering what the fancy word for abdominal fat is, it’s “android.” According to my report, it’s “associated with visceral (unhealthy) fat,” and should be less than one’s total body fat. In my case, naturally, it is not. My level of gynoid fat, which is “concentrated in hips, upper thighs, and buttocks,” is also pretty high. This, like my RSMI score, came as no surprise — I’ve been complimented more times on the size and shape of my derrière than, say, my brain or personality. Note that this is not a brag, but a sad, solemn statement of fact.
My report, thank God, wasn’t all bad news. For what it’s worth, my fat mass ratios are decent; my fat is distributed “optimally.” I may be fatter than I thought I was, sure, but at least I carry it well. And my Bone Density Z-Score says I have greater bone density than, like, 80% of the population! Looks like there won’t be any Boniva in my future. (Sadly, this is one more thing Sally Fields and I don’t have in common.)
The results of my RMR test were less soul shattering than my overall DEXA results; the process of gathering them, however, was wholly uncomfortable. While a DEXA scan merely involves laying on a table for less than five minutes, measuring the metabolic rate of a person at rest apparently requires plugging their nose, shoving a plastic tube in their mouth, and telling them not to move for a full 13 minutes. I was admonished mid-test for not breathing naturally enough with a choke-inducing, jaw-exhausting tube in my mouth, so I cannot tell you if my results are truly accurate. But I can tell you they were positive: My metabolism is ever so slightly faster than normal. So who cares if they’re accurate? It’s been a rough day, OK?
“Just because it’s easier and cheaper than ever to know what’s going on inside of us, it doesn’t mean we’re actually going to do anything to change it.”
The main purpose of an RMR test is to learn how many calories one has to consume in order to lose or maintain weight, but I was more interested in learning how many I needed to consume in order to, y’know, not die while remaining as inactive as humanly possible. It turns out the answer is 1,368 calories. By virtue of just being alive, I burn 1,368 calories each day. Which is what I do most days: merely stay alive.
According to my results, 408 is the “number of calories burn performing daily activities… working, playing, eating, etc.” But there is no section on the report that tells me how many calories I burn while watching The People’s Court, which is typically the most taxing thing I do. The results of my RMR test, therefore, mean little to me. As do the results of my DEXA scan, the more I think about it.
Sure, learning I was more fat than person was fairly unsettling. Sure, it made me feel like I should do something to TAKE CONTROL OF MY HEALTH. But, in my heart of hearts, I know I won’t do a damn thing about it. After all, just because it’s easier and cheaper than ever to know what’s going on inside of us, it doesn’t mean we’re actually going to do anything to change it. That, as you know, would require effort, and way more than $120.
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See the full story at Megan Koester