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The only sure way to determine bone density and fracture risk for osteoporosis
is to have a bone mass measurement (also called bone mineral density or BMD test).

Your doctor can help you determine whether you should have a BMD test. NOF Guidelines indicate, BMD testing should be performed on:

  • All women aged 65 and older regardless of risk factors*

  • Younger postmenopausal women with one or more risk factors (other than being white, postmenopausal and female).

  • Postmenopausal women who present with fractures (to confirm the diagnosis and determine disease severity).

*Note: Medicare covers BMD testing for the following individuals aged 65 and older:

  • Estrogen deficient women at clinical risk for osteoporosis

  • Individuals with vertebral abnormalities

  • Individuals receiving, or planning to receive, long-term glucocorticoid (steroid) therapy

  • Individuals with primary hyperparathyroidism

  • Individuals being monitored to assess the response or efficacy of an approved osteoporosis drug therapy.

Medicare permits individuals to repeat BMD testing every two years.

There are several ways to measure bone mineral density; all are painless, noninvasive and safe and are becoming more readily available. In many testing centers you don't even have to change into an examination robe.

The tests measure bone density in your spine, hip and/or wrist, the most common sites of fractures due to osteoporosis. Recently, bone density tests have been approved by the FDA that measure bone density in the middle finger and the heel or shinbone. Your bone density is compared to two standards, or norms, known as "age matched" and "young normal." The age-matched reading compares your bone density to what is expected in someone of your age, sex and size. The young normal reading compares your density to the optimal peak bone density of a healthy young adult of the same sex.

The information from a bone density test enables your doctor to identify where you stand within ranges of normal and to determine whether you are at risk for fracture. In general, the lower your bone density, the higher your risk for fracture. Test results will help you and your doctor decide the best course of action for your bone health.

Types of BMD Tests

There are several different machines that measure bone density. Central machines measure density in the hip, spine and total body. Peripheral machines measure density in the finger, wrist, kneecap, shin bone and heel.

  • DXA (Dual Energy X-ray Absorptiometry) measures the spine, hip or total body;

  • pDXA (Peripheral Dual Energy X-ray Absorptiometry) measures the wrist, heel or finger;

  • SXA (single Energy X-ray Absorptiometry) measures the wrist or heel;

  • QUS (Quantitative Ultrasound) uses sound waves to measure density at the heel, shin bone and kneecap.

  • QCT (Quantitative Computed Tomography) most commonly used to measure the spine, but can be used at other sites;

  • pQCT (Peripheral Quantitative Computed Tomography) measures the wrist;

  • RA (Radiographic Absorptiometry) uses an X-ray of the hand and a small metal wedge to calculate bone density;

  • DPA (Dual Photon Absorptiometry) measures the spine, hip or total body (used infrequently);

  • SPA (Single Photon Absorptiometry) measures the wrist (used infrequently);

With the information obtained from a BMD test, you and your doctor can decide what prevention or treatment steps are right for you. BMD tests cannot stand alone; they should always be a part of a complete medical workup supervised by a knowledgeable doctor.

Learn more about reading the results of a BMD test.

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