Ignored Risk: Bone Scans For People Over 50

“You should get a bone mineral density scan”, said the orthopedic surgeon. I had spent 7 hours of a summer Sunday in the hospital, filtering through the ER and imaging departments only to finally land in front of a kindly orthopod who explained what the deal was and what the next steps were.

Fortunately, it was a clean break and no surgery was needed, however, little did I realize this fracture was a sign of something much more sinister: a full-blown case of osteoporosis at the age of 58. For mine is a cautionary tale, dear reader, one that should be paid attention to. If my story can help even just one person avoid osteoporosis, then we at The Health Insider will have done our job.

Osteoporosis: The Silent Disease

Osteoporosis is called a “silent disease” because it progresses without noticeable symptoms until a significant event, such as the wrist fracture that I sustained.

Most people remain unaware they have the condition until a minor fall or when routine activities, like bending or coughing, result in a fracture. Common, telltale sites for fragility fractures include the hip, spine, and wrist.

Even after a fracture, osteoporosis often goes undiagnosed and untreated in many cases, which further compounds its “silent” nature.

Shockingly, according to the Report from the Canadian Chronic Disease Surveillance System 2020, of those Canadians who had an osteoporosis-related fracture, less than 20% received an osteoporosis diagnosis, underwent a bone mineral density (BMD) test or received a prescription for an osteoporosis-related medication within one year of the fracture.

Risk Factors

In Canada, the risk of having a major fracture from osteoporosis is among the highest in the world – in the top quarter. At least 1 in 3 women and 1 in 5 men will break a bone from osteoporosis. Tellingly, only 15% of Canadians aged 40+ had a BMD test according to Health Canada’s 2023 data.

With such serious gaps in care, no matter what gender you are, you should know the risk factors for this serious condition. The more you know, the better armed you are to take action to prevent further bone loss. Here are the risk factors you need to pay attention to:

• Sex – as women approach menopause in their 50’s, bone loss occurs at an increased rate. Men start to see increased bone loss after the age of 65, especially if they have low testosterone.
• Fragility fractures.
• Family history of osteoporosis or a parent with a hip fracture.
• People who are naturally thin or who have “smaller frames.”
• Long-term use of certain medications such as corticosteroids, SSRI’s, Antiepileptic medications, Proton pump inhibitors, and Heparin.
• Some medical conditions such as celiac and Chrohn’s disease, Endocrine and hormonal diseases, rheumatoid arthritis, certain types of cancer, HIV/AIDS and anorexia nervosa.
• High alcohol intake.
• Cigarette smoking.
• Not getting enough vitamin D or calcium.

Start here to assess your risk of osteoporosis.

Bone Mineral Density Scan

A Bone Mineral Density (BMD) scan, often called a DEXA or DXA scan (Dual-Energy X-ray Absorptiometry), measures bone density to assess bone health and the risk of fractures or osteoporosis. It’s a simple, non-invasive test whereby a scanning arm passes over the body, measuring bone density at specific sites, typically the lower spine and hips. Sometimes, other areas like the forearm are scanned.

In Canada, women over the age of 65, and men over age 70 at high risk for thinning bones are offered BMD scans. However, if you have any of the risk factors above, you should consider getting a scan, even if you’re under the age of 65.

If you are referred by your specialist or GP, the scan is covered by medicare. If you wish to have a Bone Mineral Density scan but your medical practitioner will not refer you, private testing is available at many facilities across the country.

The cost of a BMD scan at private facilities in Canada varies widely, ranging from $60 to $500, depending on the type of scan, location, and included services.

If you’re considering a BMD scan, check with your local clinics to understand the services included and whether a referral is required. The cost of a private scan may be reimbursed by private insurance, check with your provider.

Learn more about BMD scans in the video below.

Bone Health Starts at Home

To prevent or manage osteoporosis, people are advised to focus on a combination of lifestyle changes aimed at strengthening bones and reducing the risk of fractures. Key recommendations include:

Nutrition

• Calcium and Vitamin D: Adults should aim for 1,000–1,200 mg of calcium daily, obtained through foods like dairy products, leafy greens, almonds, and fortified foods. Vitamin D isessential for calcium absorption. Especially in the winter in Canada, adults should consider taking an 800–1,000 IU supplement daily. Sunlight exposure and foods like fatty fish, egg yolks, or supplements can also help.
• Balanced Diet: Ensure a diet rich in fruits, vegetables, and lean proteins while avoiding excessive salt, sugar, and processed foods, which may deplete bone health.

Bookmark our nutrition section to stay on top of healthy eating ==>>

Exercise + Lifestyle

Osteoporosis Canada has great exercise guidelines for people living with osteoporosis. See here to get started. Bone Fit Canada trains exercise professionals to provide safe, effective and evidence-based exercises for clients with osteoporosis. See here to find one in your area.

• Weight-Bearing Activities: Exercises like walking with a weighted vest, high-Impact Interval Training, dancing, and jogging help maintain bone density.
• Strength Training: Lifting weights and/or using resistance bands strengthens bones and muscles.
• Flexibility and Balance Exercises: Yoga and tai chi can reduce the risk of falls by improving coordination and balance.
• Avoid Smoking and limit alcohol: Smoking weakens bones and accelerates bone loss. Excessive alcohol consumption interferes with calcium absorption and bone health. Aim to consume alcohol in moderation and make a plan to stop smoking.

Watch the video below for exercises you can do at home to build bone density.

Osteoporosis Medication

Medications to treat osteoporosis aim to strengthen bones, reduce the risk of fractures, and slow bone loss. They are typically prescribed based on individual risk factors, bone density, and overall health. Osteoporosis medications fall into two categories: antiresorptive and anabolic.

Antiresorptive medications slow down bone breakdown, which can help prevent bone loss and increase bone density. Examples include:

• Bisphosphonates, such as alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), and zoledronic acid (Reclast)
• Denosumab (Prolia)
• Estrogen therapy or hormone therapy
• Raloxifene (Evista)
• Bazedoxifene and estrogen (Duavee)

Anabolic medications stimulate bone formation, which can help increase bone density. Examples include:

• Teriparatide (Forteo)
• Abaloparatide (Tymlos)
• Romosozumab (Evenity) 

Medications can come in pill, injection, or intravenous (IV) forms. The best medication for one person may not be the best for another. It’s important to understand the potential benefits and risks of any medications, and to speak with a health care provider. 

Cautionary Tale

I’ve encountered a few stumbling blocks on my journey with osteoporosis over the past few years. Initially, my endocrinologist prescribed a weekly bisphosphonate pill. After 3 weeks I had such a terrible reaction to the drug that I immediately stopped taking them: It took 6 months for the frightening toxic symptoms to abate. My endocrinologist then prescribed Raloxifene, which seems to be working well as my bone density has improved, which is no doubt due to both the drug and the lifestyle choices I make.

While I’m glad that I was diagnosed and am receiving treatment, I certainly wish that I had known about osteoporosis risk factors when I was in my early 50’s. I would have spoken with my doctor about it (the disease runs in my family) and insisted on having a BMD scan even if I had to pay out of pocket.

Instead, I’m faced with a potentially life-limiting condition which could have been avoided.

Let me know – as this happened to you? I would love to hear from our Insider community – what has your journey with bone health been like?

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The information provided on TheHealthInsider.ca is for educational purposes only and does not substitute for professional medical advice. TheHealthInsider.ca advises consulting a medical professional or healthcare provider when seeking medical advice, diagnoses, or treatment.