Researched by Marianne I
Submitted June 2001

By now I hope everyone is wondering how do I find out what shape my bones are in? There are various bone density tests available. The ones I will be writing about are available in the U.S. There are various tests available in Germany but I have not researched them. If you think you have a need to discuss it with your doctor, do so. Most likely you will have to firmly request that a test be done. Choose from the available methods, what would be most appropriate for your needs. When I was last in the States, a public screening for osteoporosis was being offered. I had to pay for this test out of my own pocket. Remember: More women develop osteoporosis than breast cancer! If it is necessary for you to pay for the test, considering your family history and life style, it might be worth every penny of the cost.

• I do not know what kind of test I had, judging from the cost ($35), it was most likely an ultrasound test. This measured the bone density in my ankle and took all of about thirty seconds. The wrist can also be checked by this method. This test can not measure the hip or spine bone density. If this test does show a loss, then it pays to have one or more of the more exact test done.



• In the U.S., the most exact test available is the dual energy X-ray absorptionmetry (DXA or DEXA). This is a very low energy x-ray test that can measure the bone density in the hip and spine, as well as the rest of the body. It is a quick and painless method of measuring bone density, but expensive. When repeated tests are necessary, if at all possible, use the same scanner since each one is calibrated differently. Otherwise, the results may not be comparable.



• The single energy x-ray absorptiometry can only measure the wrist or heel, not the spine or hip bone density. Heel and wrist bone density scans are good indicators of overall bone health. However, the hip and spine may undergo different stress and wear and tear processes, so that their bone densities may not be as good as the wrist or heel.



• The quantitative computed tomography (CT scan) has a higher radiation level and is more expensive than the DXA scan. It can measure the hip and spine.



• Finally, X-rays can show bone fractures but are not as precise as the other tests in measuring bone density.

After having been tested it is very important to be able to correctly interpret your test results. In the U.S., two numbers may be provided concerning your bone density: the "Age–matched" or "Young normal" value; the latter is also called the T-score. The T-score is what really counts because you want to know how far you are already away from the ideal value. It does not help really if your condition is referred to other people in your age group. The T-score is given in a unit called a standard deviation, or SD. This shows if your bones are more dense(+) or less dense(-) than the norm (a healthy 30-year old women).

Ideally the peak bone density is reached at age thirty and should be maintained for life. So much for ideals - the reality is often much different.

• If your T-score is +1.0, congratulations - you have optimal bone mass.



• 0.0 is the norm for a healthy 30-year-old.



• Between 0.0 and –1.0 is borderline bone mass, it is still O.K.



• Starting with –1.0 is low bone mass or the condition called osteopenia which was mentioned earlier.



• Danger: results of –2.5 or below show full-blown osteoporosis.

Under all circumstances ask your doctor for these numbers. Do not settle for an "O.K. for your age". Get the numbers so you really know your situation. It is your responsibility.

I was very happy when a week later I received my results. I was really surprised. My bones were Ok with a T-score result of -.08. Even with such good results, due to my family history of "incredibly shrinking women", it is time for me to increase my measures to maintain my bone density. In the course of the this year I will probably stop taking estrogen. A year after I have stopped I will have to have another more exact test done. With the test I took this past summer I now have a base line, just like what is recommended for a mamiograph. If I do exercise and follow a sensible diet program, then I should not have a big drop in bone loss after the discontinuation of estrogen. If I do not do my diet and exercise program as I should, then I will have a significant drop in bone loss. How good will I be?

What if your test results are not so good, or if you are concerned because of your family history? What measures can be taken to slow down, or better yet, to reverse the process of bone deterioration? Monitor your bone density. How often you should have your bone density tested (1, 2, or 5 year intervals) depends on how low your T-score is and how far your have progressed in your menopause (not yet, starting, middle, or end). Use common sense. The poorer the results, the more monitoring is necessary.