What is osteoporosis and why should you worry?
Our bones are living tissue. The bone cells are constantly being replaced by new ones, so there is an ongoing balance that keeps bones strong. Under a microscope, healthy bone looks like a honeycomb, with small holes and spaces for blood vessels and nerves.
Osteoporosis is a serious disease that causes bones to become very weak and likely to break. The word means “porous bone,” because the bones develop more holes and bigger spaces than healthy bones. When bones have more space, they lose their density and become brittle and fragile.
Half of all American adults over the age of 50 are at risk of breaking a bone.1 About 10 million Americans have osteoporosis and another 44 million have low bone density, called osteopenia.1,2 Osteopenia occurs when your body gets rid of bone cells faster than new ones can be created. Without diagnosis from screening, osteopenia can progress to osteoporosis.
What happens if you have osteoporosis?
Osteoporosis is called a “silent disease,”(3) because it develops undetected over many years, with no symptoms or pain until a bone finally fractures. Although the most common breaks occur in the spine, hip, or wrist,(4,5) advanced osteoporosis can cause a rib to fracture from even a cough or sneeze.(6,8)
As we age, we may notice that we’re getting shorter. Losing a little bit of height is natural and a normal part of getting older. But with osteoporosis, the small bones that make up our spine, called vertebrae, can fracture and collapse, causing a height loss of two or more inches.(7) These fractures occur in almost 700,000 people a year8—more than twice as many as broken hips and wrists from osteoporosis.(8)
Sometimes these breaks in the vertebrae cause pain, but 67% to 75% of them will happen without any discomfort.(7) When several vertebrae fracture, the spine becomes curved or hunched. It’s often called a “dowager’s hump” or a “hunchback.” The medical term is kyphosis, and it can lead to constant pain and pinched nerves.(3)
Osteoporosis can be debilitating. Besides pain, it can cause limited mobility, muscle spasms, depression, and other conditions.(9) The sooner it is diagnosed, with a bone density scan, the sooner treatment can begin.
What is a bone mineral density scan or test?
A bone mineral density (BMD) scan is the only test that can identify osteoporosis before symptoms appear or before a bone fractures.(10) It’s a simple, painless process that takes a few minutes, using a low-dose CT scan of the chest.(10)
A CT scan is an imaging procedure that combines X-ray and computer technology to take detailed pictures of the organs, bones, and structures inside your chest and upper abdomen. By using a CT scan, your health care provider can get much more information than from an ordinary X-ray.
Preparing for your BMD with a HeartLung™ low-dose CT scan of the chest is easy. You will not be asked to wear a hospital gown or get an injection. You can also take your prescribed medications as usual before the scan. During the BMD scan, you’ll be placed in a comfortable position. Small electrodes will be placed on your fingers. An X-ray beam moves in a circle around your chest, taking both vertical and horizontal pictures, called slices. The result is a 3D model of your chest. The scan will take about five minutes, then you’re free to go and resume all your normal activities.
Because the scan uses proprietary Artificial Intelligence (AI) technology from American Heart Technologies, all of the data is immediately analyzed, then verified by a radiology physician. Results will be available within a few hours; they are sent directly to you and to your health care provider.
How will I know if I have osteoporosis?
The results of your BMD are reported with a T-score, which is a mathematical standard deviation that tells how much your score differs from the average bone density score.(10,18)
A T-score compares your bone density to that of a healthy 30-year-old. A positive T-score number means the bone is stronger than normal. A negative T-score number means the bone is weaker than normal. The lower the T-score, the lower the bone density.
According to the World Health Organization, here is how to interpret your T-score:
T-score of -1.0 or above is normal bone density. Examples: +0.9, 0, and -0.8
T-score between -1.0 and -2.5 means low bone density or osteopenia. Examples: -1.1 and -2.2
T-score of -2.5 or below is a diagnosis of osteoporosis. Examples: -2.6, -3.3, and -3.9
Your bone density test results will also include a Z-score that compares your bone density to what is considered normal for your age, gender, and race.
Why is a BMD scan important for women?
Every year, more than 300,000 people over the age of 65 are hospitalized for hip fractures(4) due to osteoporosis. About 225,000—75%--of these fractures will happen to women.(4)
Women are at a higher risk for four reasons:
Women fall more often than men.(4)
Women have a lower bone mass than men.(3)
Women have a higher likelihood of osteoporosis.(4)
Women live longer than men.(5)
Fracturing a hip can be life-threatening. Between 63,000 and 90,000 (21% to 30%) of the 300,000 people who have a hip fracture will die within a year.(5) While more women have osteoporosis and hip fractures, men are more likely to die if they experience a fracture due to osteoporosis.(5) The sad news is that many of these deaths could be prevented with early screening.
For the fortunate 70% to 79% of those with a hip fracture who survive, treatment and recovery can take 4 to 12 weeks of rehabilitation.(11) Treatment will depend on where the fracture occurs and what is needed to repair it. If your hip is fractured, you may need a total hip replacement or surgery that requires metal plates and screws to keep your bones in place.(11)
Regaining mobility will include a plan that involves intensive physical therapy, strength and balance exercises, and some lifestyle changes. It takes about 10 to 12 weeks for the fracture to heal.(11) Even after 6 months, only 15% of people can walk across a room without assistance.(12) A full recovery can take up to a year(11), with a possibility of a lingering disability.(11)
Who is at risk for injuries that result from osteoporosis?
One half of women with osteoporosis will fracture a bone during their lifetime.(1) The incidence of fracture in these women is greater than breast cancer, heart attack, and stroke combined.(1) One quarter of men with osteoporosis will break a bone, a higher risk than developing prostate cancer.(1)
Besides being female or being over the age of 50, other risk factors include: (2, 3,5, 13)
Family history of osteoporosis
Body that is small and thin
Caucasians (especially northern European descent) and Asians
Not enough calcium and vitamin D
Not enough fruits and vegetables
Too much protein, salt, and caffeine
Too much alcohol
Inactive lifestyle
Smoking
Weight loss right before and during early menopause
What else can I learn from a low-dose CT scan?
When you choose a low-dose CT scan from HeartLung™, you will get much more than the results of your bone density scan. Our goal is to prevent disease or identify it in early stages. At the same time—and at the same price—the following organs and structures will be checked:
Heart: This heart scan, called a coronary calcium scan, is a special test that measures the plaque in the arteries that deliver oxygen to your heart. Because the plaque contains calcium, the scan can detect if it is blocking any of the arteries and if you have possible coronary artery disease before you have symptoms or an actual heart attack.(14)
Lungs: Although most cases of lung cancer occur in people who have a history of smoking, 10% to 20% of cancers happen in nonsmokers or those who have smoked fewer than 100 cigarettes in their lifetime. A lung scan detects nodules and abnormalities that don’t show up on an X-ray, allowing for early intervention before the cancer spreads.(15)
Liver: Because the liver performs so many important body functions, a CT scan can identify potential problems before they become serious or life-threatening. Tumors, infection, obstruction, and density can be seen with a CT scan.(16)
Visceral fat: A CT scan can measure the amount of fat that surrounds major organs like the liver, kidneys, and intestines. Too much visceral fat can cause inflammation, high blood pressure, type 2 diabetes, and other health problems.(17)
What do the experts recommend for women?
Since 2014, the National Osteoporosis Foundation has recommended BMD testing for all women 65 years and older, as well as BMD testing for women under age 65 if they have osteoporosis risk factors, including a fracture as an adult.(5)
Other organizations that support these recommendations are the International Society of Clinical Densitometry, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American Association of Clinical Endocrinologists, and the Endocrine Society.
Are there different recommendations for men?
The National Osteoporosis Foundation has recommended BMD testing for all men 70 years and older, as well as for men 50 to 69 years with osteoporosis risk factors, including a fracture as an adult.(5)
Other organizations that agree with these recommendations include the International Society for Clinical Densitometry, the American Academy of Family Physicians, and the Endocrine Society.
Will my insurance cover this scan?
Many insurance plans help pay for recommended screening tests. Check with your insurance plan to find out what benefits are covered for bone mineral density (BMD) screening. Tests may be covered by your health insurance policy without a deductible or co-pay as part of preventive care for special situations, such as:
You experienced menopause before age 40.
You’ve had a previous fracture from a low-impact incident.
You have a disease or condition associated with bone loss.
You’re receiving chemotherapy or radiation for breast or prostrate cancer.
Medicare Part B (Medical Insurance) covers one BMD every 24 months as part of preventive screening. You may also qualify for more frequent screenings if you meet one of the following conditions:
Your health care provider has determined that you are estrogen deficient and at risk for developing osteoporosis, based on your medical history and other findings.
Your X-rays or scans show possible osteopenia, osteoporosis, or vertebral fractures.
You are taking, or about to start to take, prednisone or other steroid-type medications.
You are being monitored to see if the medication you take for osteoporosis is working.
For more information about Medicare coverage, visit www.medicare.govexternal icon or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1 (877) 486-2048.
What else is checked with a HeartLung™ screening scan?
When you choose a low-dose CT scan from HeartLung™ you will get much more than the results of your bone mineral density (BMD) scan. Our goal is to prevent disease or identify it in early stages.
We offer an exclusive Auto-10™ scan that will provide ten detailed reports on areas of your body that cannot be evaluated by the usual physical examination or blood tests. At the same time as your bone mineral density scan—and with the same safe procedure—we can do an “internal check” and provide the following detailed reports:
Coronary Artery Calcium
Cardiac & Great Vessel Sizes
Lung Cancer Nodule Detection
Emphysema Score & Airway Measurement
Thoracic Fat & Muscle Measurements
Breast Density Measurement
Fatty Liver Disease Detection
Enlarged Lymph Nodes, Thymus & Thyroid
Hiatal Hernia & Esophageal Masses
Bone Mineral Density Measurement
Your HeartLung™ Auto-10™ scans are analyzed using Artificial Intelligence (AI), comparing them to thousands of other CT scans. Then a radiology physician will review them as part of our quality process. The detailed reports you receive are accurate and unbiased.
One more benefit of your HeartLung™ scan is that the smallest possible dose of radiation is used to obtain all Auto-10™ results. The procedure uses less than 1.5 mSv of radiation, about the same as six months of the background radiation you’re normally exposed to. By avoiding having separate CT scans, your radiation exposure in minimized.
REFERENCES:
Osteoporosis Fast Facts. National Osteoporosis Foundation, Arlington, VA. https://cdn.nof.org/wp-content/uploads/2015/12/Osteoporosis-Fast-Facts.pdf (Accessed 3 September 2021)
Starr, J. What is Osteopenia? Causes, Symptoms and Treatment. Hospital for Special Surgeries, New York City, NY. Posted on 23 May 2020. https://www.hss.edu/playbook/what-is-osteopenia-causes-symptoms-and-treatment/ (Accessed on 5 September 2021)
Osteoporosis Overview. NIH Osteoporosis and Related Bone Diseases-National Resource Center. National Institutes of Health, Bethesda, MD. https://www.bones.nih.gov/health-info/bone/osteoporosis/overview (Accessed 2 September 2021)
Hip Fractures Among Older Adults. Centers for Disease Control and Prevention, Atlanta, GA. https://www.cdc.gov/homeandrecreationalsafety/falls/adulthipfx.html (Accessed 2 September 2021.
USPSTF Recommendation Statement: Screening for Osteoporosis to Prevent Fractures. U.S. Preventative Service Task Force. JAMA. 2018;319(24): 25212531. https://jamanetwork.com/journals/jama/fullarticle/2685995 (Accessed 2 September 2021)
Katrancioglu O, Akkas Y, Arsian S, Sahin E. Spontaneous rib fractures. Asian Cardiovasc Thorac Ann. 2015 Jul;23(6):701-3. (Accessed on PubMed 6 September 2021)
Xu X, Perera S, Greenspan S. Height Loss, Vertebral Fractures, and the Misclassification of Osteoporosis. Bone. 2011 Feb 1;48(2):307-311. (Accessed on PubMed 6 September 2021)
Osteoporosis and Spinal Fractures. OrthoInfo. American Academy of Orthopaedic Surgeons, Rosemont, IL. https://orthoinfo.aaos.org/en/diseases--conditions/osteoporosis-and-spinal-fractures/ (Accessed 3 September 2021)
What is Osteoporosis and What Causes It? National Osteoporosis Foundation, Arlington, VA. https://www.nof.org/patients/what-is-osteoporosis/ (Accessed 3 September 2021)
Bone Density Exam/Testing. National Osteoporosis Foundation, Arlington, VA. https://www.nof.org/patients/diagnosis-information/bone-density-examtesting/ (Accessed 3 /September 2021)
Cluett J. Hip Fractures May Lead to a Decline In Overall Function. Medically reviewed and updated 18 February 2020. VeryWellHealth.com. https://www.verywellhealth.com/recovering-from-a-broken-hip-4138622 (Accessed on 3 September 2021)
Marottoli R, Berkman L, Cooney Jr. L. Decline in Physical Function Following Hip Fracture. J Am Geriatr Soc. 1992; 40(9):861-866. (Accessed on PubMed 6 September 2021)
Are You At Risk? National Osteoporosis Foundation, Arlington, VA. https://www.nof.org/preventing-fractures/general-facts/bone-basics/are-you-at-risk/ (Accessed 2 September 2021)
The Heart Test You May Need—But Likely Haven’t Heard Of. Johns Hopkins Medicine, Baltimore, MD. https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-heart-test-you-may-need-but-likely-havent-heard-of (Accessed 6 September 2021)
Who Should Be screened for Lung Cancer? Centers for Disease Control and Prevention, Atlanta, GA. https://www.cdc.gov/cancer/lung/basic_info/screening.htm. (Accessed 6 September 2021)
Computed Tomography (CT or CAT) Scan of the Liver. Johns Hopkins Medicine, Baltimore, MD. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/computed-tomography-ct-or-cat-scan-of-the-liver-and-biliary-tract (Accessed 6 September 2021)
What Is the Best Way to Get Rid of Visceral Fat? Medically reviewed 15 February 2018. Medical News Today. https://www.medicalnewstoday.com/articles/320929 (Accessed 6 September 2021)
Understanding Bone Density Results. Updated January 20, 2020. American Bone Health, Raleigh, NC. https://americanbonehealth.org/bone-density/understanding-the-bone-density-t-score-and-z-score/ (Accessed 6 September 2020)
When do Medicare and insurance cover DXA bone mineral density tests? Updated 12 August 2021. American Bone Health, Raleigh, NC. https://americanbonehealth.org/bone-density/insurance-coverage-for-bone-density-tests/ (Accessed 6 September 2021)