BONE DENSITY

Osteoporosis is a common disease that causes bones to become fragile and brittle. Osteoporosis causes bones to lose minerals such as calcium quicker than the body can replace them and consequently there is a reduction in bone strength and density.

oSTEOPOROSIS & BONE DENSITY

Osteoporosis causes bones to lose minerals such as calcium quicker than the body can replace them and consequently there is a reduction in bone strength and density. 

As the bone becomes thinner, even a small bump or minor fall may cause a serious fracture. Therefore osteoporosis leads to a higher risk of fractures compared to normal healthy bone. Osteoporosis is often called the ‘silent disease’ because there are usually no symptoms until a fracture occurs.

Approximately 4.74 million Australians over the age of 50 have osteoporosis or poor bone health, and ~150,000 fractures occur each year due to osteoporosis or osteopenia (low bone density). Osteoporosis particularly affects women after menopause and in their later years, although men are also affected. Physical activity and a healthy, balanced diet rich in calcium and vitamin D can help prevent osteoporosis.

How Do We Measure Bone Mineral Density (BMD)?

Scanning of the axial skeleton by dual energy X-ray absorptiometry is the gold standard in Australia for the measurement of bone mineral density (BMD). DEXA is a diagnostic tool for osteoporosis or osteopenia, enabling doctors to determine the extent of bone loss for clinical decision making.

Riverside Medical Imaging provides an accurate and convenient bone densitometry service for patients and doctors. Early detection of bone mineral loss can help prevent the occurrence of an initial fracture. For patients who may have already had a fracture, investigation with a DEXA scan and initiation of osteoporosis medication combined with a healthy diet and exercise regime is crucial to reduce the very high risk of subsequent fractures.

DETECT THE SILENT DISEASE

Osteoporosis is often called the ‘silent disease’ because there are usually no symptoms until a fracture occurs. Early detection and ongoing assessment is the key to managing this condition.

WHO SHOULD GET A SCAN?

There are many risk factors for osteoporosis. You should consider having your bone mineral density (BMD) assessed if:

  • You are over 70 years of age
  • You consume inadequate amounts of dietary calcium
  • You have low vitamin D levels
  • You are a smoker cigarette smoking
  • Your alcohol intake exceeds more than two standard drinks per day
  • Your caffeine intake is more than three cups of tea, coffee or equivalent per day
  • You have poor physical activity levels
  • You experience early menopause (before the age of 45)
  • You have lost your menstrual period due to a reduction in oestrogen levels, which is vital for healthy bones
  • You have a long-term use of medications such as corticosteroids for rheumatoid arthritis, asthma or other conditions.

Some conditions place people at a higher risk of osteoporosis. Therefore it is advised patients with the following conditions have their bone mineral density assessed:

  • Thyroid disease or an overactive thyroid gland
  • Rheumatoid arthritis
  • Chronic liver and kidney disease
  • Conditions that affect the body’s ability to absorb nutrients, such as Crohn’s disease, coeliac disease and other inflammatory bowel conditions

If you have any of the conditions immediately above, you may be eligible for medicare bulk billing, for your bone density scan. In addition, every Australian man or woman over 70 years of age is eligible for medicare bulk billing of their first scan. If a medicare rebate is not available to you, the cost of a scan is $112 and some private health funds do offer cover for bone density scans, so please check with your provider.

Do you have low bone density?

Bone density normally reaches its peak during our twenties. After that it slowly decreases as we age, for both men and women. Women are at higher risk, however, because during the years of menopause, bone density drops more quickly.

There are many things you can do to keep your bone density at its best. Talk to your GP about seeing an Exercise Physiologist, and about having your bone density assessed.

We are committed to supporting doctors in the prevention, diagnosis, treatment and management of osteoporosis.
Gerry Gardner - RMI Chief Radiographer

Bone Density is a fairly neglected area that every health professional should consider in their over-50s patients, whether male or female.

Dr Bryce Conrad - Chiropractor

Trabecular Bone Score is an excellent way to understand bone micro-architecture, and is still valid even in the presence of lumbar osteoarthritis.

Dr Angus Steventon - Chiropractor

We perform bone density scans Monday to Friday.

Bone density scans are painless, and do not involve any injections. They usually take less than 40 minutes, depending on your mobility. The results are printed out immediately, and also go directly to your referring Doctor, along with a report by a Specialist. If you have any questions, please get in touch.

BOOK ONLINE

You can book online for X-Rays, Standing Leg Length X-Rays, and Bone Densities. For other scans such as CT Scans, MRI, Ultrasounds and Dental x-rays, these are not performed at our location. Please contact PRP Imaging to have those scans performed.

FOR GPs: TRABECULAR BONE SCORE

Trabecular Bone Score (TBS) is a relatively new technology used to assist GPs and specialists in clinical decision-making when it comes to patients who are “on the borderline”, when it comes to bone density.

It may not be clear, from a patient’s BMD, whether they are moderate or high risk for future fracture. The lumbar Trabecular Bone Score can be used, in conjunction with the BMD value, to give more of a sense of whether the patient is high risk. A “traffic light system” can be used to aid your decision making.

TBS is basically a proxy for bony microarchitecture. Two post-menopausal women with identical BMD values may have very different bony microarchitecture. Thus, one might have a much higher risk of fracture due to trabecular thinning or disintegration, while the other has excellent microarchitecture and a lower risk of fracture. The ability, via TBS, to differentiate between these two ladies should hopefully allow the doctor to increase their clinical certainty, and either reassure the latter patient, or treat the former more aggressively than would otherwise have occurred.

Here are some key points regarding TBS (based on this article– Journal of Bone and Mineral Research, Vol. 29, No. 3, March 2014, pp 518–530):
  • The trabecular bone score (TBS) is a gray‐level textural metric that can be extracted from the two‐dimensional lumbar spine dual energy X‐ray absorptiometry (DEXA) image.
  • TBS is related to bone microarchitecture and provides skeletal information that is not captured from the standard bone mineral density (BMD) measurement. Based on experimental variograms of the projected DXA image, TBS has the potential to discern differences between DXA scans that show similar BMD measurements.
  • An elevated TBS value correlates with better skeletal microstructure; a low TBS value correlates with weaker skeletal microstructure.
  • Lumbar spine TBS has been evaluated in cross-sectional and longitudinal studies, and the following is the consensus, at this point:
  1. TBS gives lower values in postmenopausal women and in men with previous fragility fractures than their non-fractured counterparts;
  2. TBS is complementary to data available by lumbar spine DEXA measurements;
  3. TBS results are lower in women who have sustained a fragility fracture but in whom DEXA does not indicate osteoporosis or even osteopaenia;
  4. TBS predicts fracture risk as well as lumbar spine BMD measurements in postmenopausal women;
  5. Efficacious therapies for osteoporosis differ in the extent to which they influence the TBS;
  6. TBS is associated with fracture risk in individuals with conditions related to reduced bone mass or bone quality.

TBS Traffic Light System

TBS: Only at Riverside Medical Imaging

TBS is only offered on the Central Coast at Riverside Medical Imaging. We have invested heavily in this technology because we believe that it has the potential to assist GPs and endocrinologists to “sort the sheep from the goats” when it comes to how aggressively to treat a patient with low bone density.

For more information, please phone us to discuss an education session. We also have research papers available for GPs and specialists to peruse.

References
  • Journal of Bone and Mineral Research, Vol. 29, No. 3, March 2014, pp 518–530
  • Journal of Bone and Mineral Research, Vol. 26, No. 11, November 2011, pp 2762–2769
  • Anderson, K. B., Holloway‐Kew, K. L., Hans, D. , Kotowicz, M. A., Hyde, N. K. and Pasco, J. A. (2019), Reference Ranges for Trabecular Bone Score in Australian Men and Women: A Cross‐Sectional Study. JBMR Plus, 3: e10133. doi:10.1002/jbm4.10133