2007-02-10 / Columnists

Maintaining Your Health on Mackinac

Bone Density Testing Is Important in Preventing Fractures
By Yvan Silva, M.D.

Bone densitometry is a simple, painless, and easily available test. It is non-invasive and quantitatively measures bone mineral density (BMD) at selected sites to determine whether thinning of bones has occurred relative to the age and sex of an individual, in the context of overall bone health. Bone mineral density is strongly correlated to the strength of bone, and studies have shown a strong association between BMD and fractures of the hip particularly.

Low bone density is called osteopenia. Osteopenia is not a disease, and when present it is not specifically an indication for treatment. However, it is an objective indicator if there is thinning of bones that can pose a risk for possible fractures. Osteoporosis, on the other hand, is an abnormal condition in which the bones are weak and brittle and easily susceptible to fractures, especially of the vertebrae. Older individuals can have undiscovered osteoporosis that becomes evident after a fracture, often after an injury that seems trivial. In the overall prevention of fractures in older individuals, bone density tests can play an important role. When bone density is found to be abnormal, lifestyle modifications can help to slow the process and reduce the risk of fractures.

There are several factors that are important in assessing increased risks for fractures, above and beyond the assessment of bone density. The chance of sustaining a fracture increases with age. Poor eyesight can lead to falls, and should be corrected when possible, especially since most fractures result from falls. There is a strong correlation between smoking and weakening of bones. Drinking more than two drinks of alcohol a day increases the risk of hip fractures. White women have a higher incidence, two to three times greater risk than men or black or Hispanic women. Previous fractures pose a higher risk. A history of fractures in a parent also suggests a risk. Certain medications, like corticosteroids and others known to cause bone loss, increase the risk. Several chronic medical conditions are associated with increased risk - stroke, rheumatoid arthritis, diabetes, neurological conditions like Parkinson's disease, and others. Spine fractures are usually associated with osteoporosis and occur with a particularly high rate of additional fractures.

When it is indicated, usually in conjunction with a regular physical examination at an appropriate time, a bone density test will help in establishing the occurrence of osteopenia. Again, this is not a disease but an assessment of bone density relative to age and sex and other overall physical health. Preventing fractures is an important goal during aging.

Maintaining a healthy weight is important, achieved by a balanced diet and regular daily physical exercise. Weight-bearing exercise such as walking is helpful for building muscle, stabilizing mobility and balance, maintaining bone and joint function, and overall fitness. Vitamin D is important. Exposure to sunlight, about 10 minutes a day, provides the body with the opportunity to synthesize vitamin D. Vitamin D-fortified foods are useful, as are vitamin D supplements when needed. Calcium, obtained in dairy products, leafy green vegetables, or calcium supplements, is also important for bone health. Smoking is contraindicated because of the deleterious effects.

Medications are available to help in the management of conditions associated with higher risk for fractures. When osteopenia is present, strengthening of bone can be achieved by lifestyle modifications - diet, exercise, weight maintenance, and overall fitness are important. Treatment of osteoporosis with medications that slow bone loss and increase bone density, hormone-based therapies, and others are available. They should be used under careful monitoring by your physician because of the potential for risks and side effects.

Dr. Silva is a professor of surgery at Wayne State University and a resident of Woodbluff on Mackinac Island.

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