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How to Get Maximum Benefit from Your Bone Density Tests

My bone density test results had a major impact on my life. They motivated me to take up strength training and create a more effective and well-rounded exercise program for myself. They showed me how to modify my exercise routine in order to put less stress on skeletal areas of abnormal wear. The results also prompted me to improve my posture, have a better balance of bone nutrients and write this book. All of these preventative steps helped me reverse my bone loss, prevent back problems, and improve my muscle strength and balance. But I wouldnít have received these benefits had I not asked for copies of my bone density reports, studied them and discussed them with medical professionals.

      Part of the research for this book involved interviewing more than 100 people about their bone density test experiences and examining some of their bone density reports. The majority of these people never saw a copy of their density report and never discussed it face to face with their doctor or test center. Unfortunately many of the DXA centers in the U.S. that discussed results with patients are closed now because of decreased reimbursements from Medicare and insurance companies. When I was first tested in 2001, the cost of a DXA test typically ranged from $120-$200. Now doctor-operated centers are usually paid less than $75 so they can't provide the same level of service. If you want both legs scanned, plan on paying extra.

       Iíve created this web page and my book to help you have a more productive bone testing experience and get maximum benefit from your bone density test(s). Iíve noticed that patients who are proactive, informed and willing to make requests are the ones who tend to get the best service and medical care. This web page responds to the following issues:

1. How can I make the density tests of my spine and hips as worthwhile as possible?

2. What types of information are known at the time of a density test of the spine and hips?

3. What information is determined by the radiologist?

4. Why should I get both hips tested instead of just one?

5. Why should I get an original copy of my bone density report from the test center?

6. What should I look for when choosing a bone density test center?

7.  Is a doctor's order or referral required for a bone density test?

 

1. How can I make the density tests of my spine and hips as worthwhile as possible?

  • Select a test center that will provide thorough reports of the lower spine and both hips, if you can find one. Offer to pay extra if necessary. A good report is normally at least three pages in length and includes images of your spine and hips. A one-page summary page does not provide adequate information. Chapter 15 of Osteoporosis Prevention provides information on evaluating bone density reports and selecting test centers.

  • Schedule your bone density test about a month or so before your annual physical or other doctor's appointment, if possible. That way you'll be able to get the report in time to discuss the results face-to-face with your regular doctor.

  • Learn about bone density tests and terminology before you get tested. One of the reasons I wrote Osteoporosis Prevention is to help you understand your reports and ask appropriate questions at the test center and at your doctorís (See Chapters 13Ė15 & 17). The images of your spine and hips on the monitor will be more meaningful if you already know the anatomy and significance of the areas of your body that are tested. (Ideally, you will have chosen a test center that is willing to show you your images and discuss your test results.)

  • Get an original copy of the bone density report from the test center before seeing your doctor.  A detailed report has a variety of valuable information, and it can help determine which type of exercise is best for you. However, it's impossible to assimilate it all by just talking to a doctor during an office visit. You need to see and read the written report to fully understand it.

  • Study the report and learn the terminology on it so that youíll be able to have a constructive discussion with your doctor(s) about your options for treatment and prevention. Read the fine print and foot notes on the report because they sometimes contain important information.

  • Write down any questions you may have about your test results in the order of their importance. Otherwise you may forget to ask them or waste valuable time discussing unimportant topics or terminology that you should have learned beforehand. Time will be limited.

  • If you have osteoporosis, get a referral to a physical therapist from your regular doctor (or the osteoporosis specialist if you saw one). Proper exercise is one of the most important means of treatment and prevention, but some exercises are better and safer than others. Youíll need to do more than walk. Physical therapy is typically covered by insurance and government medical plans if you have osteoporosis, but check first to see if itís included in your plan. Even one or two sessions can be helpful if the therapist helps you set up a good exercise program, checks your posture and verifies that youíre doing the exercises correctly and with proper form. The therapist should also have a copy of your bone density report.

2.  What types of information are known at the time of a density test of the spine and hips?

  • The numeric and relative bone densities of general and specific areas of your hips and lumbar (lower) spine. These are immediately provided by the densitometer (the machine that measures your bone density). The densities of the individual sites can be helpful for determining which type of type of exercise may be most appropriate and whether or not there is significant asymmetry.

  • The amount of change between your previous and current results if you were previously measured on the same densitometer and the significance of these changes. Graphs may be included.

  • X-ray type images of your lumbar spine and hips, which can be enlarged to see specific areas more clearly. There may be both positive and negative images. These images show visually the areas of greatest and lowest density, the structure of the hip and lumbar spine, areas of bone degeneration, and occasionally some compression fractures. The images are clearer and larger than those on the written report.

  • Your hip axis lengths and relative fracture risk on some densitometers.

  • A comparison of the relative densities of the right and left hip and a comment about whether significant asymmetry is present or not.

3. What information is determined by the radiologist?

  • The overall diagnosis, which is used to determine if and which type of drug therapies are appropriate. This is always included.

  • An assessment of the spine density, preferably determined on an individualized basis, not by a default computer setting. Arthritic changes can lead to falsely elevated spine scores. Consequently the radiologist must look at the data and images to determine if some vertebrae should be excluded from the calculation of the overall lumbar spine density.

  • An assessment of fracture risk

  • Comments about the images relating to problems such as poor alignment, areas of degeneration, or fractures if present.

  • Recommendations for treatment and/or prevention and follow-up tests.

  • A comparison to the patientís results done on a different densitometer, when applicable, or comments about comparisons of results on the same densitometer.

  • Comments about areas with the lowest relative bone densities.

4. Why should I get both hips tested instead of just one?

     Because there might be a significant difference between the bone densities of the two hips. The hip with the lowest densities will normally have the higher fracture risk. Significant variations in densities should lead you to ask why thereís a difference. Perhaps you donít walk evenly, or you rest on one hip more than another while standing, or maybe one leg is shorter than another and requires a lift. Over the long term, skeletal imbalances can lead to joint and back problems.

     When monitoring the effects of drugs or exercise, itís helpful to have two sets of hip scores. If all of the BMDs in both hips go up, the positive results are more conclusive than if only one hip had been measured.

    The densitometers manufactured in the 1990's tended to be very slow so measurements were done only of one hip. The new densitometers are fast. Therefore, many bone density test centers started to measure both hips since it was so easy and quick to do them both. However, when Medicare reduced their reimbursement rates, DXA centers had to cut services. Medicare and insurance companies pay the same for measuring one leg as for two. 

     Before being tested, verify that the center will do both hips. Sometimes itís just a matter of requesting that both hips be measured. The more complete your report, the more helpful it can be.

5. Why should I get an original copy of my bone density test(s) from the test center?

     One of the main reasons is that the graphs and images of your spine and hip will be clearer and sharper than on a photocopy of the report from your primary care physician. Another reason for getting an original copy is that the newer reports are often in color. A black and white photocopy from your doctor wonít give you the benefits of a color report. If you ever need to see an orthopedist, chiropractor, endocrinologist, rheumatologist, or physical therapist, it may be helpful for them to see a clear copy of your bone density report. If they want a photocopy, it will be better quality if itís from an original. You should keep a file of your medical reports so you can track your medical progress and history. Institutions and doctors can discard them after a fixed number of years, typically seven. However, sometimes the records get lost, misplaced or destroyed in a fire, or the holder of the report goes out of business. None of this will matter, as long as you have an original copy of the report. Ask if it is possible to get a digital copy of the report f you provide a thumb drive or CD. 

6. What should I look for when choosing a bone density test center?

     Some test centers take an active role in osteoporosis prevention by discussing test results and preventative measures with their patients. Others merely do the test. Itís best to select a center that will discuss your test results with you. However, they may be difficult or impossible to find now that reimbursements are so low. The technologists or doctors at the center have specialized knowledge about bone density testing and are able to show you the images of your spine and hip on the monitor. Consequently, theyíre able to provide information thatís unavailable from your primary care physician. The better understanding you have of your bone health, the more motivated youíll be to take preventative measures and the more productive your discussion with your regular doctor will be.

    Itís important to choose a test center that provides detailed reports. A thorough report will typically be four or more pages in length and will contain images of your spine and hip. The majority of the information is generated by the densitometer. A one page summary report is not sufficient. In order to get maximum benefit from your test, you and your doctor should have the supporting data and images that were used to determine the overall diagnosis.

     Ask in advance if the test center scans both hips. If they do, this is an indication that they have an up-to-date densitometer and care about giving you a complete report. If they donít, ask if theyíre able and willing to do both hips if they are paid a fair price.

     Of course the center should have a competent staff, but this may be hard for a patient to determine. If the test center provides thorough reports and is able to discuss the results with you, this a good sign of quality care.

7. Is a doctor's order or referral required for a bone density test?

     If you get tested in a doctor's office, a referral is normally not required. However, most imaging centers and hospitals require a doctor's order for a bone density test. In my opinion anybody who wants a bone density test and is willing to pay for it should be able to get one without a doctor's order. Referrals are not required for mammograms, lung scans, heart scans and full body scans, all of which have a significant amount of radiation; yet most test centers require a doctor's order for a DXA test, which is safe and has minimal radiation. I don't understand why. 

For more information consult:

Osteoporosis Prevention: A Proactive Approach to Strong Bones & Good Health

Webpages with sample reports:

GE DXA Bone Density Report

GE DXA Body Composition Report

Hologic DXA Bone Density Report

Hologic DXA Body Composition Report

Spine TBS Report

Mindways QTC Bone Density Report

General Sample Reports Web Page

Conversion Tables

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