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If my clinician does not discuss screening for osteoporosis, at what age should I make sure that I am screened?

You and your clinician should discuss your bone health during every annual exam, regardless of your age. Your calcium and vitamin D intake, your level of physical activity, and your lifestyle factors such as smoking and drinking alcohol can affect bone health at any age.

If you believe that you have one or more risk factors for developing osteoporosis, it is important to discuss being screened with your clinician.

If you believe that you have one or more risk factors for developing osteoporosis, it is important to discuss being screened with your clinician (see Question 12). The Surgeon General, in his 2004 report on bone health, advises that the following "red flags" at any age should warrant further assessment for osteoporosis or other bone diseases:

• Fracture following mild or moderate trauma (e.g., fracture after falling from standing height or less; see Question 74)

• Low body weight or weight loss of over 1% per year in elders

• Loss of height or progressive curvature of the spine

• Family member with bone disease

• Delayed puberty

• Atypical ending of menstrual periods (e.g., early menopause)

• High levels of alkaline phosphatase (a liver enzyme) or serum calcium in persons who are otherwise healthy

• Anorexia nervosa

• Amenorrhea, either due to intense physical activity, eating disorders, or hormonal imbalances

• Treatment with medications that affect bone remodeling (e.g., glucocorticosteroids; see Question 15)

• Presence of disease that is associated with secondary osteoporosis (see Question 16)

• Overproduction of thyroid or parathyroid hormones or intake of high thyroid hormone doses

• Prolonged immobilization

• Calcium deficiency (caused by inadequate calcium intake or poor absorption)

• Vitamin D deficiency (caused by low intake through diet or supplements[1] or by poor absorption)

Can my clinician tell if I have osteoporosis during my annual check-up?

It is very important that your clinician take a good history during your annual check-up. The history is particularly important because osteoporosis is not painful unless you break a bone. Your clinician should ask you about the following:

• Family history of osteoporosis

• Personal history of fractures

• Presence of chronic or new acute back pain

• Menstrual history including menopause (surgical or natural); amenorrhea

• Medications that can cause secondary osteoporosis (see Question 15)

• History of illnesses that are associated with secondary osteoporosis (see Question 16)

• Lifestyle factors such as cigarette smoking, heavy alcohol consumption, and activity level

• Intake of calcium and vitamin D

After taking a thorough history, your clinician will examine you. For the purposes of detecting osteoporosis or for conditions that put you at increased risk of developing osteoporosis, your clinician should pay particular attention to the following:

• Height loss—actually measuring your height using a stadiometer is important

• Low body weight on petite frame, BMI < 22; or BMI > 28

• Elevated pulse and blood pressure (for overproduction of thyroid hormone)

• Tooth loss

• Enlarged thyroid gland

• Tenderness over bones of your back

• Curvature of the spine (kyphosis)

• Limited range of motion in the spine, shoulders, elbows, wrists, hips, knees, or ankles

• Shortened distance from the rib cage to the front edge of the pelvis while lying down face-up (happens when spine begins to curve from repeated fractures)

• In men—smaller testicles may indicate loss of testosterone (related to hypogonadism)

• In women—breast and pelvic exams may show evidence of estrogen loss.

Even after collecting all of this information, your clinician cannot determine if you have osteoporosis. They use this information to determine your risk for osteoporosis and then will order testing if needed (see Question 23).

Penny's comment:

Since age 65, I have had a complete yearly physical, blood work, urinalysis, and so forth. When I reached age 79, my doctor thought it would be a good idea to have a bone density test. My left hip showed the beginnings of bone loss, but only to the degree of "osteopenia." I then started taking 1200 milligrams of calcium, plus vitamin D.

At this year's exam, my doctor noted it had been 3 years since my last bone density test. I was sent to a bone specialist's office for the tests. I had a scan of my ulna and radius. After that I was led into another room for a spinal x-ray because I had a compression fracture a little more than a year ago in the thoracic region of the spine. My hip was also tested.

Lying on that white x-ray table was an ordeal I would not like to face again. Not only was the room cold, but also the hard smooth surface of the table was like ice, and maneuvering me into the position they desired was very painful. I do have the beginnings as well of arthritis, and some of the movement, not noticeable on standing and normal movement, caused a great amount of discomfort.

After the tests were done and the results printed out, I was given a stack of papers to look at, and they were compared against the bone structures of some unknown 30-year-old to give me a score that assured me of the diagnosis. After all the tests, I was diagnosed with the real thing—osteoporosis.

It was a shock to me. Two years ago, my orthopedic doctor told me at the time I was put in the brace for the compression fracture in my back that this might happen again and to keep the brace handy. He also mentioned that there were some signs of arthritis at the time. But he never actually told me that I had osteoporosis.

When you reach age 82 plus, you expect some aches and pains and creaking joints and a feeling of malaise once in a while, but you never put a name to it because the next day it can be better.

Now that I have been told unequivocally that I have osteoporosis, I feel mentally stooped inside. From what I can tell by looking in the mirror, though, my spine is not nearly as curved as those on the diagrams hanging on all four walls in the osteoporosis specialist's office.

I was told I had a choice of three medications to keep the deterioration of the bone to a minimum. I chose weekly Actonel®. I have to be cautious and take it exactly as directed so that I don't get more stomach upset than I already have.

I was also told to take an extra 400 mg of vitamin D once a day to ensure a better response to the 1200 mg of calcium I am also taking. The calcium levels in my blood are normal. The specialist also wanted me to exercise. I told her that lifting art supplies for my painting class, walking up and down the aisles of the grocery store every day, and doing my leg exercises at home would have to be enough exercise.

I can laugh, and groan, and complain about how growing old takes courage. I just hope that between now and the time I return to the doctor, I will have regained my sense of humor, and be grateful the sun is still shining and that I am NOT walking with a cane, a walker, or sitting slumped in a wheelchair.

  • [1] Additional doses of vitamins, minerals, or other dietary substances; usually taken to enhance diet to get the recommended amount for your age, gender, and medical conditions.
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