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When Should You Get Your First DEXA Scan?

You Might Need a DEXA Scan Sooner Than You Think

While both the National Osteoporosis Foundation and the International Osteoporosis Foundation recommend that all adults age 65 have a DEXA scan to test your Bone Mineral Density (BMD) there are numerous risk factors that may indicate that it’s a good idea to have a baseline DEXA scan done at an earlier age.

 

What is a DEXA scan?

DEXA (or sometimes DXA) stands for dual-energy x-ray absorptiometry.. When we see the word x-ray, we often associate that with exposure to radiation, however exposure to radiation from a DEXA scan is equal about one-tenth of the radiation of a standard chest x-ray and less than a day’s exposure to natural radiation. During a DEXA scan, which takes about 10 minutes, you’ll lie on a table with an imaging device beneath. Results from a DEXA scan are reported as both a T-Score and a Z-Score.

 

Your First DEXA Scan: Understanding DEXA Test Results

DEXA Scan results are reported as a T-Score and a Z-Score. A T-Score is a comparison of BMD with a healthy adults of the same sex (at birth) at the peak of bone mass. (Peak bone mass for women occurs between 20-30 years of age.) A Z-Score compares your BMD with the average of your peers.

 

For older adults, osteoporosis is diagnosed using the T-Score as indicated in the chart below.


A table showing Diagnostic Criteria for Osteoporosis
Diagnostic Criteria for Osteoporosis

 

Risk Factors that May Indicate the Need for a DEXA Scan Before Age 65

 

According to the National Institute of Health the following factors that may increase your risk for osteoporosis and warrant earlier bone mineral density screening:


  • Gender at Birth. Your chances of developing osteoporosis are greater if you were born female. However, those born male are still at risk, especially after the age of 70.

Graph of Bone Mass by Age for Males and Females
Graph of Bone Mass by Age for Males and Females

  • Age. As you age, bone loss happens more quickly, and new bone growth is slower. Over time, your bones can weaken and your risk for osteoporosis increases.

  • Body size. Slender, thin-boned women and men are at greater risk to develop osteoporosis because they have less bone to lose compared to larger boned women and men.

  • Race. White and Asian women are at highest risk. African American and Mexican American women have a lower risk. White men are at higher risk than African American and Mexican American men.

  • Family history. Researchers are finding that your risk for osteoporosis and fractures may increase if one of your parents has a history of osteoporosis or hip fracture.

  • Fall history. People who have a tendency to fall are at higher risk of fracture.

  • Changes to hormones. Low levels of certain hormones can increase your chances of developing osteoporosis. For example:

    • Low estrogen levels in women after menopause.

    • Low levels of estrogen from the abnormal absence of menstrual periods in premenopausal women due to hormone disorders or extreme levels of physical activity.

    • Low levels of testosterone in men. Men with conditions that cause low testosterone are at risk for osteoporosis.

  • Diet. Beginning in childhood and into old age, a diet low in calcium and vitamin D can increase your risk for osteoporosis and fractures. Excessive dieting or poor protein intake may increase your risk for bone loss and osteoporosis.

  • Other medical conditions. Some medical conditions that you may be able to treat or manage can increase the risk of osteoporosis, such as other endocrine and hormonal diseases, gastrointestinal diseases, rheumatoid arthritis, certain types of cancer, HIV/AIDS, and anorexia nervosa.

  • Medications. Long-term use of certain medications may make you more likely to develop bone loss and osteoporosis, such as:

    • Glucocorticoids and adrenocorticotropic hormone, which treat various conditions, such as asthma and rheumatoid arthritis.

    • Antiepileptic medicines, which treat seizures and other neurological disorders.

    • Cancer medications, which use hormones to treat breast and prostate cancer.

    • Proton pump inhibitors, which lower stomach acid.

    • Selective serotonin reuptake inhibitors, which treat depression and anxiety.

    • Thiazolidinediones, which treat type II diabetes.

  • Lifestyle. A healthy lifestyle can be important for keeping bones strong. Factors that contribute to bone loss include:

    • Low levels of physical activity and prolonged periods of inactivity can contribute to an increased rate of bone loss. They also leave you in poor physical condition, which can increase your risk of falling and breaking a bone.

    • Chronic heavy drinking of alcohol  is a significant risk factor for osteoporosis.

    • Studies indicate that smoking is a risk factor for osteoporosis and fracture. Researchers are still studying if the impact of smoking on bone health is from tobacco use alone or if people who smoke have more risk factors for osteoporosis.


Knowledge is Power: Resources for Determining Your Osteoporosis and Fall Risk

Since you need a prescription for a DEXA scan, it’s important to discuss risk factors with your doctor to determine whether it is beneficial for you to test your Bone Mineral Density sooner. With low Bone Mineral Density, knowledge is power. The earlier you are aware of low bone mineral density, the faster you can take action.


There are plenty of Osteoporosis and Fall Risk Calculators available online that can help you determine whether you are at an increased risk for osteoporosis, falls, or fragility fractures and are a candidate for an early DEXA scan.


When to Get Your First DEXA Scan: Key Takeaways about Bone Mineral Density, Osteoporosis, and Fall Risk

·The National Osteoporosis Foundation and the International Osteoporosis Foundation recommend that adults get their first DEXA scan, which measures Bone Mineral Density (BMD), at age 65. However, certain risk factors may necessitate earlier screening. These factors include:

gender (those born female are at higher risk)

  • age

  • body size

  • race

  • family history

  • fall history

  • hormonal changes

  • diet

  • medical conditions

  • long-term use of specific medications

  • lifestyle factors like physical inactivity, chronic heavy drinking, and smoking

·

A DEXA scan, which uses minimal radiation, provides results in the form of a T-Score and a Z-Score, comparing an individual's bone density to peak bone mass and age-matched peers, respectively. Discussing risk factors with a doctor can help determine the need for an early scan.


Since an adult over 50 falls every minute in the U.S., engaging in regular physical activities, such as resistance, impact, and dynamic balance training, is crucial for maintaining bone strength and preventing falls.


If you're ready to be proactive about your bone health, reach out to schedule a consultation or join me each Wednesday at 9am EST via Zoom for a beginner friendly strength class. Can't make it live? No problem... I'll send the recording right to your inbox!


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