Bones [01] Bone Density: Is It Safe for Everyday Use and Ongoing Use
Bones [01] Bone Density is a useful term for understanding the mineral density of bone, a assessable indicator of the amount of mineral in bone tissue. Bone density is not fixed throughout life, and low bone density may contribute to a tendency toward fracture. But a bone density number doesn't capture every aspect of skeletal health.
This guide details how bone mineral density is measured, what DXA results and T-scores mean, nutrients and exercises that help maintain bone health, and important limitations to consider. It also addresses common questions about a 1.7 result and if it’s good, which vitamin is most important, what is a concerning bone-density score, and if a T-score can get better.
What Does Bone [01] Bone Density?
Bones [01] Bone density is the amount of minerals, especially calcium and phosphorus, in bone tissue. Dense bone usually gives more structural support. Decreased bone mineral density to a significant degree may make fractures more likely. Bone is living tissue that is constantly being reshaped as old bone is cleared and new bone is created.
The most common clinical measurement is a DXA (dual-energy X-ray absorptiometry) scan. The hip and spine are common sites of assessment of fracture risk, often evaluated using the central DXA. The test is quick, noninvasive and has a relatively low level of radiation. Bone density measurements can be used to evaluate osteoporosis, to detect density that is below normal, and to observe changes that occur during treatment.
Bones [01] Don't confuse Bone Density with overall bone quality. Bone strength is also influenced by other factors, including bone structure and turnover, geometry, falls, muscle strength, medications, age, and medical conditions. As such, a single number should be considered in the light of an individual’s overall fracture risk, and not as a complete picture of skeletal health.
How Does Bone [01] Density Function?
Bones [01] Bone Density is related to the balance between bone formation and bone resorption that is occurring. Specialized cells clear away older bone while other cells create new tissue. Bone formation during childhood and early adulthood usually surpasses bone loss and bone mass grows. As we age, this balance can be altered toward losing more bone, especially after menopause and with other conditions that alter hormone levels or bone metabolism.
A DXA scan provides a measurement of bone mineral density and routinely lists a T-score and, when appropriate, a Z-score. The T-score compares the measured bone density with the average density of a healthy young-adult reference population. It is used for post-menopausal women and men 50 years and older. Generally a T-score of -1 or higher is described as normal. A score from -1 to -2.5 is osteopenia, and a score of -2.5 or lower is in the osteoporosis range.
Bones [01] The testing site, equipment, position and normal variability in the measurement may also alter the Bone Density results. In younger adults, premenopausal women, and children, clinicians more often focus on the Z-score, which compares bone density to an age- and sex-matched reference population. That's why you can't just rely on one number when you're looking at a report.
Bones [01] Importance of Bone Density
Healthy Bones [01] Bone Density helps to form the mineralized framework to hold up the body and protect organs. Adequate bone density is correlated with increased skeletal tissue and may be associated with diminished fracture risk. Healthy bones also interact with muscles to help support movement, posture and physical activity.
Weight-bearing and resistance exercise may help preserve aspects of skeletal health. Brisk walking, climbing stairs, dancing, resistance band exercises and strength training place appropriate mechanical stress to bones. Exercise can also improve muscle strength and balance, which can help decrease the risk of falling. However, those with osteoporosis or a history of fractures may need an individualized exercise program, as some high-impact movements can raise the risk of injury.
Normal bone maintenance involves adequate calcium, vitamin D, protein and overall nutrition. Calcium is an important structural mineral and vitamin D contributes to the body in absorbing calcium. Good nutrition is good, but more than the recommended amount of supplements will not lead to stronger bones and may even have the unintended result.
It could also mean addressing factors that accelerate bone loss to keep bone density healthy. Smoking, heavy alcohol use, prolonged inactivity, some medications, hormonal changes, and some medical conditions can all change skeletal health. While it may be important to address a particular underlying factor, not all causes of low density can be corrected by lifestyle measures alone.
Bones [01] Potential Side Effects and Risks of Bone Density
Bones [01] Bone Density is not a medical treatment or medication and it has no adverse effects. The risk, if any, would be related to how the bone density is measured or treated. A DXA scan is a relatively low-dose x-ray, and the body is exposed to a small amount of radiation. Peripheral screening devices may have a role in some settings but do not necessarily provide the same diagnostic information as central DXA of the hip and spine.
Supplements also need to be administered appropriately. Some people can have digestive symptoms such as constipation with calcium supplements and too much calcium can be inadvisable for some people. Vitamin D supplements are beneficial when diet or blood levels are low, but too much can lead to vitamin D toxicity and excess calcium in the blood. Therefore, by default, supplements should be a adjunct to a well-rounded diet, not a replacement for nutrition.
In the right patients, prescription drugs for osteoporosis can help reduce the risk of fracture, but each drug has its own potential side effects and contraindications. The decision to treat is based on bone density, history of fractures, age and other risk factors and medical conditions. However, a lower T-score does not automatically mean that medication is indicated for every individual. And just as a relatively normal score doesn't rule out every possible fracture risk.
Who Needs Bones [01] Bone Density?
Because Bone [01] Bone Density is a health assessment and not a product, the more useful question is, Who should consider bone-density testing? Current routine screening guidelines in the United States are directed toward women 65 years of age and older and younger postmenopausal women with sufficient risk of fracture. Testing may also be considered if a clinician identifies other risk factors for skeletal loss or fracture.
Low bone density can also develop in men and younger people. Risk factors include a history of a fracture, long-term use of certain drugs like glucocorticoids, low body weight, hormonal problems, malabsorption syndromes, smoking, heavy drinking, and a family history of osteoporosis or hip fracture. The appropriate testing strategy will differ according to age and individual circumstances.
People with osteoporosis or osteopenia may undergo regular DXA testing to follow changes. However, repeat testing at very short intervals is not necessarily useful because changes in bone density can be minimal and may be within the normal variation of the test. The timing of follow-up testing is usually determined for each person.
Bones [01] Bone Density Versus Other Options
[01] Bones Bone Density testing is separate from other ways of reviewing bone health. Bone mineral density is commonly measured at the hip and spine using central DXA, and other areas such as the wrist or heel are measured using peripheral tests. Quantitative ultrasound offers some information on bone properties but cannot stand in for central DXA for the diagnosis of osteoporosis.
Bone-density tests are not like blood tests, either. Blood tests can identify vitamin D deficiency, abnormalities in calcium, thyroid problems, kidney problems or other conditions that can cause bone loss but do not directly measure bone mineral density. When investigating unexplained low bone density, a clinician may bring together several types of information.
Lifestyle strategies are another key alternative or complement to testing and treatment. Exercise, good nutrition, not smoking, drinking alcohol responsibly, fall prevention and appropriate medical care can all promote bone health. These measures support the skeleton but should not substitute for prescribed treatment for osteoporosis where there is a high risk of fracture.
Where to Arrange Bones [01] US Bone Density
Bone mineral density testing is commonly available in the United States through hospitals, medical centers, imaging facilities, and other healthcare organizations that carry out DXA services. Depending on the facility and the patient’s situation, testing may be recommended by a physician or other qualified health care professional. Insurance coverage and eligibility can depend on the plan, so it’s best to review costs before scheduling a scan.
A healthcare professional can advise whether central DXA or another type of testing or lab evaluation-or no testing at this time-is reasonable. The results should be assessed according to age, sex, fracture history, medications, medical conditions and other risk factors, not judged on the numerical value alone.
Questions and Answers About Bones [01] Bone Density
What is a typical bone density?
A single bone-density value of 1.7 is not enough to call it good or bad. DXA reports are normally understood using T-scores or Z-scores. The importance of a raw BMD value is affected by the measurement site, scanner, reference population, and other factors. 1.7 is T-score or 1.7 g/cm^2 ? If it is T-score it is a very different result. The interpretation requires the complete set of results.
What vitamin is best for building bone density?
No single vitamin has been shown to increase bone density in everybody. Vitamin D is especially important because it supports the body absorb calcium and maintain normal bone metabolism. But healthy bones also benefit from enough calcium, protein and other nutrients. Correcting a vitamin D deficiency may improve your bones, but taking high doses when you don’t have a deficiency won’t necessarily support bone density and could do harm.
What is considered a unfavorable bone density score?
In postmenopausal women and men age 50 or older, a T-score between -1 and -2.5 is typically described as osteopenia. A T-score of -2.5 or lower is in the osteoporosis range. Lower scores usually correspond to lower bone mineral density and a higher risk of fracture. However, treatment decisions also factor in fracture history, age, medications, and other clinical risk factors.
Can I change my T-score for bone density?
In some cases, bone density may improve or be stable enough to improve or maintain a T score. Bone health can be strengthened by resistant and weight bearing exercise, adequate calcium and vitamin D, sufficient protein intake, avoidance of smoking and appropriate medical treatment. However, changes may be slow, and some people are mainly interested in avoiding further decline rather than seeing a big increase in density.
What is a standard bone density T score?
A T-score of -1 or above is usually considered to be within the normal range for populations in which T-scores are used. It's not that there are no fractures, or that the bone qualities are all normal. Risk of fracture is also related to age, previous fractures, medications, falls, medical conditions and other factors that may not be represented by the T-score.
Osteoporosis and osteopenia are different disorders, but they are related.
Not at all. Osteopenia is a low bone mineral density (BMD) that is below the normal range but not low enough to meet the definition of osteoporosis by DXA. A T-score between -1 and -2.5 is generally in the osteopenia range and -2.5 or lower is in the osteoporosis range. Osteopenia can still be connected with significant fracture risk, especially in the presence of other factors.
Foods that may be useful that are useful for supporting bone density:
Calcium, vitamin D, protein and other nutrients in foods can support normal bones. Examples include dairy products, calcium-fortified foods, calcium-fortified tofu, some greens, fish, eggs and other nutrient-dense foods. Food choices should be suited for the person’s total dietary needs. Nutrition alone will not be sufficient by itself to treat established osteoporosis or significantly increased risk of fracture.
Does walking improve bone mass?
Walking is a weight-bearing exercise that may help maintain bone health and physical function. It may support bone and is most effective when combined with resistance and balance exercises. The effect on bone mineral density, however, is affected by age, fitness, skeletal site and exercise intensity. So, walking should be viewed as one component of a comprehensive bone-health strategy, not as a reliable shortcut to improve a T-score.
How often should I schedule my bones checked?
There is no one-size-fits-all interval for testing. The follow-up DXA testing depends on the initial result, age, fracture risk, treatment status and other clinical factors. The measurement variability of DXA makes too frequent testing difficult to interpret for small changes. The health care professional can establish the appropriate interval between tests based on the reason for testing and the individual’s risk profile.
Vitamin D alone is not enough to increase bone density.
Vitamin D is needed for absorption of calcium and for normal skeletal function, especially in the individual with deficient vitamin D. However, vitamin D alone is not a panacea for low bone density. Adequate calcium, protein, physical activity and management of underlying medical conditions are also important. Combination of prescription treatment with nutrition and lifestyle measures may be needed for osteoporosis.
[01] Bone Density Closing Thoughts on Bones
Bones [01] Bone density is best understood as a starting point when looking at bone mineral density, testing and fracture risk than as one treatment or a definite way to rebuild bone. DXA testing may offer useful information, but T-scores have to be assessed according to age, sex, testing site, medical history and other risk factors.
Good nutrition, the appropriate type of physical activity, steps to prevent falls, not smoking or drinking too much alcohol, and medical treatment when needed are usually key to good bone health. Bone density changes are incremental and fracture risk is individual, so it’s more useful to consider the big picture than one number or one nutrient.