by Wendy Warner, MD, ABIHM
There has been a lot of “hoopla” around bone density testing and treatment for osteoporosis in the past few years. After many years of popularity, bisphosphonates like Fosamax are now being viewed with much more skepticism and concern by both the public and many health professionals alike.Often, a midlife woman (who may even still be menstruating!) will undergo a DEXA scan at her doc’s suggestion…..and when it shows osteopenia (low bone mass, but not yet osteoporosis), she’s told she needs treatment. However, our use of DEXA scans may very well be skewed in this country. It appears that the correlation between the results of a DEXA scan and true fracture risk is not as clear cut as some may suggest. There is more to good bone than simply density.
Yes, it’s nice to have loads of minerals in the bone making it more dense. However, it’s also essential to have strong protein/collagen matrix in which that mineral resides. This is what gives bone flexibility. Often, even if the bone is less dense, if the matrix is strong, the bone simply bends and doesn’t break. The DEXA report for such a bone, though, will look poor.
The World Health Organization developed a tool called a “FRAX” score in an effort to give women and men a more clear idea of true fracture risk. It includes individual clinical information along with the results of a DEXA scan, which is likely more relevant than the DEXA alone. It is easily available as an online tool and I suggest that you check it out here: http://www.sheffield.ac.uk/FRAX/tool.jsp?country=9 (Please note that this is for US Caucasians; you will find other links on this site for other ethnic groups that will be more accurate).
It is an everyday occurrence in our office to sit with someone who is concerned about her bone density, run the numbers into the FRAX tool and show her that her risk isn’t nearly as high as she thought. In fact, a family member recently had rather alarming-looking results on her DEXA, but really didn’t want to go back on the Fosamax that she stopped years ago. When we ran her score, she saw that her true fracture risk was something she felt comfortable with, so now she isn’t worried about not going back on the drug.
Why hasn’t your other doc already shown you this? Well, likely that she just got busy and didn’t think of it. Or maybe he really does listen to pharmaceutical reps. Or maybe they believe in sticking to the protocols provided by the insurance companies they’ve contracted with. Most of these talk about DEXA scans but not FRAX scores.
Check this out yourself and make your own decision. You’ll need an actual copy of your most recent DEXA report. Or maybe pull out your smart phone with this link during your next office appointment and ask your doc to look it up with you. It might open their eyes.