Wrong Question! What you should be managing is Fracture Risk. If you only look at Bone Mineral Density (BMD), you miss the chance to decrease Fracture Risk in the overwhelming majority of people.
85% of the women who Fracture have a DXA score of “osteopenia” or even “normal”. Keeping their bone density at “only osteopenia” does them no favor. So how can you manage Fracture Risk?
FRAX (the Fracture Risk Assessment Tool) can help. It should be part of any evaluation. BMD is 30% of the calculation in FRAX. Other risk factors make up the other 70%. Go to www.shef.ac.uk/FRAX to see the calculator.
Age is a huge factor. A woman of 50 with a T-score of -3.1, a woman of 60 with a T-score of -2.5, and a woman of 80 with a T-score of -1.3 (barely into “osteopenia”), all have the same Fracture Risk if all other factors are equal.
If a person has a Hip Fracture or a Vertebral Compression Fracture of 25% or more, that person has “Clinical Osteoporosis” (a High Risk of Fracture), and should be treated. Use Vertebral Fracture Assessment (VFA) to screen for Vertebral Compression Fractures.
A person on Prednisone, Steroid Inhalers, Aromatase Inhibitors for Breast Cancer, or Androgen Deprivation for Prostate Cancer should be treated, regardless of DXA T-score.
Find out what Your Personal Fracture Risk is. Get a Complete Bone Health Evaluation. Then Take Control of Your Bone Health.
Jay Ginther, MD