Bone Density Testing

Bone loss and osteoporosis are often silent conditions with minimal symptoms until a fracture occurs. Fractures can cause pain, disability and loss of independence. Both fear of fracture and fracture itself can affect your quality of life and get in the way of doing the things you love. To optimize your bone health and prevent this from happening, it is imperative to increase awareness as well as undergo proper screening and bone density testing.

Current statistics tell us that bone density testing screening rates are declining, and only about 10% of those who should be screened are getting the proper testing. What’s even more alarming is that over 43 million people in the United States alone have low bone mass or are at risk for osteoporosis, and most don’t even know it.

Even more, research shows that traditional bone density testing used today is not the best approach anymore. The traditional test is called a Dual Energy X-ray Absorptiometry or DEXA scan more commonly. This method uses a low radiation x-ray to determine the mineral composition of your bones. It essentially is measuring the mineral density which is predictive of fracture but tells us nothing of bone quality. 

Three new bone density testing methods may hold more promise for their ability to measure both quantity of bone mineral density AND quality. 

  • DEXA with TBS
  • Echolite REMS
  • Dynamic CT

If you’re at risk for osteoporosis or are concerned about your bone health, learning more than just your bone mineral density can be helpful in deciding what to do next! Keep reading to learn when to get tested and which of these three testing methods is best for you. 

When to Get A Bone Density Screening

Current recommendations for bone density screening are primarily based on age, which is typically 65 and older for women and 70 and older for men. Men and women may be tested between 50-70 years old when combined with risk factors such as a history of fractures or have other instances associated with bone loss such as a diagnosis of rheumatoid arthritis or chronic steroid use. 

Unfortunately, simply testing based on age is not nearly enough, and focusing solely on this one factor is a disservice. There are several other non-age-related risk factors for bone loss such as:

  • A history of an eating disorder 
  • Chronic stress
  • Poor gut health
  • Genetics and family history
  • A sedentary lifestyle
  • Poor diet or nutritional deficiency
  • Regular alcohol or cigarette use
  • Diabetes, prediabetes or metabolic disease
  • Adrenal dysfunction
  • Chronic Inflammation
  • Use of steroids in the past for more than 7 days
  • Use of medications for depression (SSRI) or GERD (PPI)

If you consider this list carefully you will probably realize that it will include MOST adult and  early screening can lead to improved outcomes and can prevent debilitating fractures just by being proactive. 

Bone Density Testing Methods

DEXA

DEXA is the traditional bone density test done via a low dose X-ray to see how dense and strong your bones are. A machine is used to do this, where it sends beams that measure how much radiation passes through your bones. These measurements are sent to a computer that then calculates your bone density.

Unfortunately, over time, it has become apparent that this traditional DEXA method is not always the most accurate in detecting bone loss. The results are very susceptible to variations based on different machines, how you are positioned on the machine, and even down to the X-ray technician performing the study. It also uses ionizing radiation which we should limit our exposure to but the dose is very small. 

DEXA also only looks at bone quantity and does not address the more important measure of quality. The next three testing methods below all address quality as well.

DEXA with TBS

This method uses a DEXA machine as well but gives a more detailed picture of bone density. It is relatively new and utilizes special software that analyzes the internal structure of the bones to give a more complete assessment of how strong they are. TBS stands for Trabecular Bone Score and is able to provide a more precise score for bone quality and overall fracture risk.

Echolite REMS

This method stands for Radiofrequency Echographic Multispectrometry. It measures bone density as well as quality, without the need for ionizing radiation. Based on the findings from a recent clinical study involving over 4,000 women, REMS testing was seen to be more specific and sensitive to identifying those at risk or diagnosed with osteoporosis compared to DEXA. It was also excellent in accurately identifying patients with previous fractures. Even though REMS is not yet standard practice, at Optimal Bone Health we believe it should be the number one testing method for these reasons. 

Dynamic CT

Dynamic CT is a computed tomography (CT or CAT) scan of the bone. This method tests bone density by performing a CT scan rather than using an X-ray machine, which provides a more detailed analysis.

The main difference between Dynamic CT and DEXA is that with Dynamic CT the X-ray beam moves around a circle in the body, which allows for more views of the bone. This produces more thorough data that is sent to a computer to interpret the results. Because Dynamic CT provides more detailed information on the bone tissue and structure than DEXA, it can provide further insight into past injuries or disease in the bone.

Maintaining Strong Bones with Proper Screening

Awareness and early screening are key pillars when it comes to optimizing bone health. This is why at Optimal Bone Health we always take a proactive rather than a reactive approach. 

The signs of bone loss are often hidden, and so knowing the answers early on can prevent a fracture and preserve your quality of life for years to come, especially when you undergo a more accurate test such as Echolite REMS.

If you are concerned about your bone density test results, our Optimal Bone Health Team can help you understand your numbers and create an individualized plan to stop your bone loss. Schedule a 15 minute consultation to learn how OBH can help you optimize your bone health!

Doug Lucas
Author: Doug Lucas

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