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Testing Bone Health Accurately

November 21, 2018

 

 

Bone health is critically important, impacting so much else in our physiology like dental health, posture, digestion, and sex. We often confuse bone health with the health of the joints, which are related but not identical.

 

Some of what we know is based on the way you walk, run, or stand, in that way your trainer can help establish some facts of your bone health!

 

My favorite test of bone health is to take out my sewing tape. I first then measure your height, and then I use it to measure your wing span, and they should be (approximately)  the same, but often aren't. Women with a wing span w that out measures your height then it's possible you have lost bone mass and have a vertebral fracture.

 

What is your height? Was it measured accurately? We have also discussed the fact that poor posture, and collapse of the vertebral bodies will cause you to lose height and you need to be aware of that as well. The spine should remain straight as we age, unless you previously had twists and turns called scoliosis. Muscles inserting into bones should not be painful either, or over time this will impair exercise and lead to bone weakening.  Establishing the true diagnosis, and planning treatment requires your gyno to know more about your individual bone health.

 

Nutrition and hormones contribute to bone health, so checking for anemia, calcium, Vitamin D and the hormones that control Vitamin D, as well as metabolic breakdown of bones can be a large window into the secret of bone health. Thus blood and urine tests of markers of bone turn over can be helpful in evaluating bone health as well.

 

It is known that thicker bones are healthy. According to many bone health organizations, including the National Osteoporosis Organization and American College of Obstetricians and Gynecologists bone density testing will determine that thickness and assign you a score that is useful for fracture prediction. I heard a recent expert refer to the fact that even a score that is the "definition" of osteoporosis" which would be a T score of -2.5 or less, should be called "compatible with, but not diagnostic of osteoporosis." Remember that women with bone diseases other than osteoporosis can have low scores, and that osteoporosis is a disease of bones being more fragile than they were when they were younger so that they are more susceptible to breaking, and  a score cannot predict your actual bone structure or the presence or absence of other bone diseases as accurately as having a piece of bone biopsy we can look at under a microscope (not done routinely!).

 

Some gynos and primary care physicians  even use Bone Density T scores of -2.0, or the FRAX score, most accurately a FRAX score calculated by the addition of Total bone structure analysis, or even the presence of fractures on x-rays to determine their definition of osteoporosis.

 

If  you have been diagnosed with osteoporosis think about getting blood testing for secondary causes of osteoporosis, including testing your kidneys, testing for vitamin D, testing your thyroid, looking for blood disorders and liver and kidney disorders just to name a few conditions that may be related that should be checked. In your overall health screening you need a comprehensive evaluation.  So don't just stop at a bone DXA, go the next step in your evaluation with your gyno.

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