Bone density screenings help diagnose mineral loss that increases your risk of fractures and other injuries.
Preventive screenings are an important part of staying healthy. These tests are performed to identify potential medical problems early, when they are easier to treat or manage. Many are covered by Medicare.
Bone density tests are a type of preventive screening that tells your doctor how strong your bones are. Covered by Medicare if you meet certain criteria, they are primarily used to diagnose osteopenia and osteoporosis. These screenings are also valuable for early detection of bone loss, so you can take steps to protect your health.
Knowing your risk for osteoporosis and whether you should get a bone density test can help ensure you get the screenings and care you need before a problem occurs. Here is more information about bone density tests, including Medicare coverage criteria, as well as more about osteoporosis and how to prevent it.
What is a bone density test?
Also known as dual energy X-ray absorptiometry (DEXA) and bone mass measurement screening, bone density tests are performed by your doctor to help measure the amount of minerals in your bones. This imaging study uses a small amount of ionized radiation, as well as an X-ray machine, to calculate the strength of your bones and find deficiencies that could be caused by age, certain diseases, fractures, or other problems in your bones.
Primarily, this test can help determine if you have or need treatment for osteoporosis, which is a condition that causes brittle bones and fractures in older adults. The DEXA scan measures the spine, hip, or total body, and is considered the most useful and reliable test for checking bone density.
Is a bone density test covered by Medicare?
Yes, bone mass measurement scans are covered once every 24 months by Medicare Part B if you meet one or more of the following criteria:
- You're a woman whose doctor determines you are estrogen deficient and are at risk for osteoporosis
- Your X-rays show possible osteoporosis, osteopenia, or vertebral fractures
- You're taking prednisone or steroid-type drugs, or are planning to begin this treatment
- You've been diagnosed with primary hyperparathyroidism
- You're being monitored to see if your osteoporosis drug therapy is working
If medically necessary, this scan may be covered more often. Your doctor may have to provide proof of a reason for more frequent testing, but additional scans will likely be covered. If the provider accepts Medicare assignment, there is no cost to you.
What to expect with a bone density test
There is nothing you need to do to prepare for a bone density test.
When you get to the facility, you'll likely be asked to change into a gown first. You may receive a contrast material either by mouth or through a peripheral intravenous line (IV), which helps produce better images.
Once you're ready, the scan will take about 10 to 30 minutes depending on the areas of the body being scanned. Typically, the hip or spine is tested, but can also be done on the radius bone in the forearm. It can depend on the facility's equipment and your particular needs.
After your test, the doctor will view the images and use specific calculations to assign a T-score, which compares your current bone density to that of a healthy adult at age 30. The three T-score categories include:
- Normal: -1 or higher (such as 0 or +0.5)
- Low bone density: between -1 and -2.5
- Osteoporosis: -2.5 and lower
Depending on your results, your doctor will recommend treatment options.
What is osteoporosis?
Osteoporosis, which affects about 54 million Americans, is a disease in bones that happens when the body loses too much bone, makes too little bone, or both. Bones that lose density or mass and contain abnormal tissue structure are less dense, making them weaker and more likely to break from a fall or other injury.
Osteoporotic bone breaks are most likely to occur in the hip, spine, or wrist, which can cause not only pain but even permanent damage. For example, osteoporosis in the vertebrae or spinal bones can lead to a stooped or hunched posture. It can also limit mobility and make daily tasks difficult.
Osteoporosis risk factors
There are many risk factors that increase your chances of developing osteoporosis, some of which are within your control and others are not.
Age: While the risk increases with age for everyone, women over age 50 or postmenopausal women have the greatest risk
Gender: Women undergo rapid bone loss in the first 10 years after menopause, but osteoporosis can also affect men
Ethnicity: Caucasian and Asian women are at a higher risk
Bone structure and body weight: Petite or thinner people have a greater risk due to having less bone to lose than people who weigh more or are taller
Family history: Those with parents or grandparents who had osteoporosis are at a higher risk
Some medical conditions: Most commonly, conditions that increase risk are related to irregular hormone levels, and can include
- Autoimmune disorders such as lupus, multiple sclerosis, and rheumatoid arthritis
- Blood diseases such as multiple myeloma or leukemia
- Celiac disease, or inflammatory bowel disease
- Chronic kidney disease
- Endocrine/hormonal disorders such as diabetes, premature menopause, low levels of testosterone and estrogen, or Cushing's syndrome
- History of bariatric surgery or organ transplant
- History of missed periods
- Hormone treatment for breast or prostate cancer
- Neurological/nervous system disorders such as stroke or Parkinson's disease
- Overactive thyroid, parathyroid, or adrenal glands
- Poor diet, including malnutrition
Medications: There are some medications with side effects that may damage bones that could lead to osteoporosis, including steroids, treatments for breast cancer, and seizure medications
Eating habits: Calcium and vitamin D are important to prevent osteoporosis
Lifestyle: Inactive or sedentary lifestyles are higher risk
Talk to your doctor about which risk factors you may have, and steps you should be taking to minimize those factors.
Osteoporosis doesn't have many symptoms because you don't feel your bones weakening. Typically, the first sign of osteoporosis is breaking a bone. You may also notice you're getting shorter, your upper back is curving forward, or you're experiencing height loss.
Treatment for osteoporosis
If you've been diagnosed with osteoporosis, your doctor will recommend treatment depending on your risk of breaking a bone. If you're at high risk, they may recommend medications. If you're lower risk, you may instead focus on modifying risk factors that are in your control.
For example, if you smoke, the first step is to quit. If you consume more than two alcoholic drinks per day, lower your alcohol consumption to avoid decrease in bone formation as well as risk of falling. You can also lower your risk of falling and breaking a bone by wearing low-heeled shoes, shoes with nonslip soles, and clearing your home of electrical cords, rugs, or slippery surfaces that may cause you to fall.
Medications may include bisphosphonates, denosumab, hormone-related therapy, or bone-building medications.
How to avoid osteoporosis
There are a few things you can do to help prevent osteoporosis, primarily focused around good nutrition and regular exercise. Additionally, you can:
- Increase your calcium intake, either by consuming good sources of calcium (like low-fat dairy products, dark green leafy vegetables, soy products, or calcium-fortified cereals and orange juice) or through a calcium supplement. It's recommended to hit the daily intake of 1,000 mg for women 50 and younger, and 1,200 mg for women 51 and older.
- Get enough vitamin D, which you can do through absorbing sunlight, or eating foods such as cod liver oil, trout, salmon, and some milk and cereals. Recommendations are 600 international units (IU) per day if you're 70 or younger, or 800 IU if you're 70 or older.
- Get a bone density test (when eligible)
If you believe you're at high risk for osteoporosis, especially if you meet one or more of the above risk factors, talk to your doctor about additional steps you should take to reduce your risk and avoid complications.
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