Bone Densities- Really Necessary?

As part of the Choosing Wisely campaign, the American Academy of Family Physicians has released our top five recommendations for tests and procedures that patients and doctors should question. Today, I am focusing on the third issue: bone densities. The recommendation is this:

Do not use dual-emission X-ray absorptiometry (DEXA) in women younger than age 65 or men younger than 70 with no risk factors.

We now know that using these bone density scans are not cost-effective in younger, low risk patients. This simply means we do not need to ROUTINELY do bone densities as part of the well woman exam each year. Please note that I did NOT say NEVER to use this test! In patients with risk factors for thinning bones, bone densities can give us excellent information.
What are risk factors?
--Family history of osteoporosis (Do you have tiny, hunched over, little old ladies for grandparents?)
--Thyroid disease (especially people who have been over-replaced for under active thyroid disease)
--Smoking
--Excessive alcohol intake (>2/day)
--History of a fracture without having trauma
--Age over 65 and Female, or 70 & Male
--Caucasian or Asian
If you have one, or especially, several of these risk factors, your doctor may indeed suggest getting a bone density test, and she should!

BOTTOM LINE: Bone density testing should not be a ROUTINE screen for everyone, but reserved for those with risk factors.

"Break a Leg"- No, Please do NOT!

At the risk of sounding like an alarmist, today's post, like yesterday, carries a warning from the FDA. Today's concern regards the medications we prescribe to help INCREASE your bone strength- the bisphosphonates- commonly known as Fosamax, Fosamax Plus D, Actonel, Actonel with Calcium, Boniva, Atelvia, and Reclast. The FDA Drug Safety Communication: Safety update for osteoporosis drugs, bisphosphonates, and atypical fractures was issued today regarding unusual leg fractures that see to be occurring in women who have been on these drugs for five years or more.

Do the medications CAUSE the fractures? How common is this? Well, we're not really sure yet. What we do know is that the fractures are located either just below the hip joint or in the long bone of the thigh, and these types of fractures represent less than 1% of leg and hip fractures. However, 94% of the people with these fractures had been taking the bisphosphonate medications. Of course, there are huge numbers of people taking these drugs, and the study found only 310 cases of these fractures, so each person's individual risk of getting a fracture is quite low.

What should you do if you take a bisphosphonate? Number one- don't worry! There is a much greater chance that your medication is PREVENTING you from getting a fracture than potentially causing one. Have a discussion with your physician about your risks and benefits, and make a decision together at your next exam.

Remember the things YOU can do to strengthen your bones: get enough calcium in your diet (especially when you are young, so help your daughters!), enjoy weight-bearing exercise like walking and jogging, limit your caffeine, get your sunshine vitamin (D) and make sure your thyroid medication is not over-replaced!

BOTTOM LINE: Be aware that medications taken for thin bones may carry some extra risk, and as always, focus on what you can do to improve your bone strength!