Read the BMD Testing Interval ISCD Response to NEJM Article that was recently released.
This test is one of the pillars in the diagnosis and management of osteoporosis. Osteoporosis affects more than 2 million Canadians. While 1 in 8 women have a lifetime risk of developing breast cancer, 1 in 4 women have a lifetime risk of developing osteoporosis (1 in 8 for men).
Just as hypertension (high blood pressure) is generally asymptomatic and is the leading cause of congestive heart failure, osteoporosis is also silent and only becomes apparent when a bone is fractured from what would generally be considered a minor fall (fragility fracture). Hence the term applied to osteoporosis is that of a “silent thief”. The bones that are commonly involved include the wrist, hip and spine.
Risk factors for osteoporosis include age over 65 for women and men, vertebral compression fracture, fragility fracture after age 40, family history, >3 months use of glucocorticoid drugs and medical conditions that inhibit absorption of nutrients.
A diagnosis of osteoporosis and associated fracture risk has significant implications for future fragility fractures. This is important because almost 30% of patients who sustain a hip fragility fractures will die of complications from the fracture. Another 40% will spend the rest of their lives in a long-term care or rehab facility. Only 30% will be able to go back home.
A diagnosis of osteoporosis can be established with Bone Density Testing (available at the Toronto Centre for Medical Imaging). The site has been accredited by the Ontario Association of Radiologists (OAR) Bone Density Accreditation Program since 2009. The technologist is certified by the International Society for Clinical Densitometry (ISCD) and by the OAR. The reporting radiologist is a Certified Clinical Densitometrist (CCD) with more than ten years experience in the interpretation of Bone Density studies.
(Source: Osteoporosis Canada, www.osteoporosisca)
Indications for Bone Density testing include one or more of the following:
- Age greater the 65 (for men and women)
- Fragility fracture after age 40 years
- Prolonged use of glucocorticoids (at least 3 months cumulative in the past year at more than 7.5 mg per day)
- Use of other high risk medications (Dilantin, aromatase inhibitors such as tamoxifen, arimidex or androgen deprivation therapy)
- Parental hip fracture
- Vertebral fracture or demineralization of bone on radiography
- Current smoking
- High alcohol intake
- Low body weight (less than 60 kg) or major weight loss (more 10% of body weight at age 25 years)
- Rheumatoid arthritis
(Source CMAJ October 2010)
At the Toronto Centre for Medical Imaging, bone density testing is available by appointment during regular business hours from Monday to Friday with short (less than 1 week) wait times. As with all our studies, we accept requisitions from for any physician licensed in Ontario and you can count on being taken in on time for your appointment.Call our front desk at 416 368 8488 to book an appointment.
Osteoporosis is a condition that causes bones to become thin and porous, decreasing bone strength and leading to increased risk of breaking a bone.
- The most common sites of osteoporotic fracture are the wrist, spine and hip.
- No single cause for osteoporosis has been identified.
- Osteoporosis can strike at any age.
- Osteoporosis is often called the ‘silent thief’ because bone loss occurs without symptoms.
- Osteoporosis can result in disfigurement, lowered self-esteem, reduction or loss of mobility, and decreased independence.
- Osteoporosis has been called a paediatric disease with geriatric consequences.
- Building strong bones during childhood and adolescence can be the best defence against developing osteoporosis later.
- Peak bone mass is achieved at an early age, age 16 in girls and age 20 in young men.
- Women and men alike begin to lose bone in their mid-30s; as they approach menopause, women lose bone at a greater rate, from 2-5 per cent per year.
- Risk factors include age, vertebral compression fracture, fragility fracture after age 40, family history, >3 months use of glucocorticoid drugs and medical conditions that inhibit absorption of nutrients.
- Loss of 1 1/2″ (4 cm/6 cm if over 60) or more in height may be an indicator of spinal fracture.
Facts and figures
- Almost 2 million Canadians are living with osteoporosis.
- 1 in 4 women and at least 1 in 8 men over 50 have osteoporosis.
- The cost to the Canadian health care system of treating osteoporosis and the fractures it causes is currently estimated to be $1.9 billion annually.
- At least 80% of fractures in people 60+ are related to osteoporosis.
- Osteoporosis causes 70-90% of 30,000 hip fractures annually.
- Each hip fracture costs the system $21,285 in the 1st year after hospitalization, and $44,156 if the patient is institutionalized.
- Hip fractures related to osteoporosis result in death in up to 30% of cases.
- 23% of patients who fracture a hip die in less than a year.
- Osteoporotic hip fractures consume more hospital bed days than stroke, diabetes, or heart attack.
- Less than 38% of fracture patients in Canada currently undergo diagnosis or adequate treatment for osteoporosis.
- Without BMD testing, 80% of patients with a history of fractures are not given osteoporosis therapies.
- A study recently reported that only 44% of people discharged from hospital for a hip fracture return home; of the rest, 10% go to another hospital, 27% go to rehabilitation care, and 17% go to long-term care facilities.
- A 50-year-old woman has a 40% chance of developing hip, vertebral or wrist fractures during her lifetime.
- The lifetime risk of hip fracture is greater (1 in 6) than the 1 in 9 lifetime risk of developing breast cancer.
- Patients are at highest risk for subsequent fracture in the first few months following a vertebral fracture.
- 1 in 4 women who have a new vertebral fracture will fracture again within one year.
- Both vertebral and hip fractures are associated with an increased risk of death.