Health Secrets	UPDATED: Thursday, April 20, 2006
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What’s Your Bone Density Level?

Posted on Monday, May 01, 2006

If You Don’t Know, You Are at Risk

By Wendy J. Meyeroff
THE ERICKSON TRIBUNE

Every year, approximately 1.5 million people age 62 and over find their lives changed by fractures of the hip, spine, or wrist. Of the 300,000 hip fractures each year in both men and women, an average 25 percent die within a year. Those fractures usually occur because the bones have been weakened by osteoporosis, a loss of bone mineral density (BMD).

A simple, painless, BMD test, which takes about 20 minutes, can determine someone’s risk of osteoporosis. Yet despite increasing awareness of the importance of bone density testing, most older people still don’t have a BMD test performed regularly, and few of their doctors recommend it.

This year Erickson HealthSM opened its new Bone Health Centers at Charlestown and Oak Crest, communities in Maryland built and managed by Erickson. The centers feature a state-of-the art DXA bone density scanners and are headed by JoAnn Caudill, R.T., C.D.T., a radiologic technologist certified in bone density testing.

“Osteoporosis is so prevalent in an older population that we felt it was important to provide screening right on site for residents of this community built and managed by Erickson. The easier it is for them to access a bone density test, the more likely they are to have one. Our Bone Health program, the first of its kind in a continuing carecommunity, is just one more reflection of our commitment to preventive health care for residents of communities built and managed by Erickson,” says Matt Narret, M.D., chief medical officer for Erickson Retirement Communities. The test costs $140 and is generally covered by insurance.

Understanding Your BMD Score

The scanners give Caudill a reading of her patients’ T-score and Zscore. “The T-score compares bone density to that of a healthy 30-year-old, the age at which most experts agree bone mass peaks. The Z-score compares your bone density to someone the same age, gender, and race,” says Caudill.

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The key number is the T-score. “We expect an older person’s T-score to be lower than a 30-year-old’s, but how much is the standard deviation (SD)? A normal bone density scan shows a T-score with an SD better than -1; a scan between -1 and -2.5 indicates osteopenia (the beginning of bone loss, putting you at risk of osteoporosis) and you have osteoporosis if your T-score is lower than -2.5,” she says. (These numbers are based on scores for white women; experts still haven’t set standards for different ethnic groups or men.)

Getting Accurate Readings

There are three things that make the scans Caudill performs different from one a resident would likely find outside the Erickson HealthSM system. “I scan the spine and wrist, and also both hips (some facilities only do one side). I do a side view of the spine if the patient’s history indicates a need. It’s not uncommon to detect different levels of loss at different body sites,” Caudill says.

Consistency is important. “I prefer every patient change into a gown. I don’t want to scan you in your summer shorts and T-shirt and another time in a heavy sweater and long wool pants. It’s just one more variable that could skew a reading,” she adds.

Counseling is Critical

“JoAnn only sees one patient an hour and she takes a complete history. No matter what the results, she talks with the resident,” says Narrett. “If they show healthy bones, we want to keep it that way and provide education on prevention. If they are showing signs of osteoporosis, we want to prevent further loss,” Caudill explains.

The Bone Health Centers feature row upon row of packaged goods, ranging from fiber-packed cereals (allowing her to discuss fiber-calcium interactions), to dairy products, to baked beans. Baked beans? “Yes, they contain calcium. I teach residents how to read food labels. So if a label says ‘4% calcium’ I explain that just adding a zero to that percentage number—change 4 to 40—and that is how many milligrams of calcium the serving indicated will add to your diet. So you would get 40 mg. of calcium from this particular 1/2 cup serving of baked beans. However, you would need 12 cups of baked beans to get the calcium in three 8-oz. glasses of milk,” says Caudill. Older men and women need 1,200 mg. of calcium every day (as opposed to 1,000 for people under age 50)

The Vitamin D Factor

Vitamin D improves the body’s absorption of calcium “It used to be thought 400 I.U. of vitamin D was the gold standard, but now we recommend people age 62-plus get 600 I.U. and some studies indicate that 800 I.U. might be better,” says Narrett.

Calcium is easy to find in food (see chart in the Calcium story), but vitamin D’s main source is still sunlight. Unfortunately fewer people are going outside, or using sunblock when they do. Some experts recommend waiting about 15 minutes before putting on your sunscreen,” says Caudill. Taking a calcium supplement with at least 400 I.U. of vitamin D and some fortified milk (which contains vitamin D) should bring you to your needed daily allotment.

“Remember, osteoporosis is a silent disease. You don’t want to wait ‘til you have symptoms. Get scanned and take steps to fight bone loss even if you don’t think you need to,” Narrett concludes.