Bone Health Diagnostics: What Should Be Ordered and How Often

By Victoria Newcom, FNP

It is no secret that as we age, our bone density decreases or weakens. Through this decline, the risk for breaking a bone increases, especially by falling. Some individuals also may notice poorer dental health and notice their teeth are more prone to breaking, cavities, cracks, etc. So how do we know what diagnostic tests to order and when?

Among the general population, it is advised to have a bone density test in women over the age of 65, or men over the age of 70. A younger individual, aged 50-64, that is at an increased risk should consider getting tested earlier. This would include breaking a bone in a minor incident, having rheumatoid arthritis, celiac disease, hyperthyroidism, hyperparathyroidism, smoking, drinking heavily, having a low body weight, extremely limited physical activity, consistent use of corticosteroid drugs, post-menopausal status in women, or a strong family history, to name a few. If you fall into this category, talk with your doctor to discuss the risks and benefits and determine if it would be appropriate to have further testing completed.

For any individual that has had bariatric surgery, as a part of your routine labs on at least a yearly basis, your physician should check your serum calcium, phosphorus, vitamin D, and parathyroid hormone (PTH) labs to help assess your risk for osteomalacia (softening of the bones) and/or osteopenia/osteoporosis (weakening of the bones). These tests carry very little risk. If you have had bariatric surgery in addition to having another chronic disease that would increase your risk (as mentioned above), you may talk with your doctor about further diagnostic testing. The best test in order to diagnose osteoporosis is a DEXA (dual energy x-ray absorptiometry) bone scan, which is a kind of x-ray. Conventional x-rays are of little help, unless you have already broken a bone.

The frequency in which you should have a DEXA scan completed will be determined based on several factors including your age, your previous bone density results, and whether you are already taking an osteoporosis treatment medication. If your bones are healthy and you have not been identified as having an increased risk, your next test could be scheduled 5-15 years later. If you have been identified at a greater risk, your next test could be as soon as 1-2 years later. Since bone loss is generally pretty slow, there is usually little need for more frequent tests. However, if you are concerned about osteoporosis, it is important to speak with your physician to develop a plan.