T-Scores and Your Health

By Susan Tulino, Novant Health UVA Health System

Osteopenia (thin bones) and osteoporosis (brittle bones) aren’t life-threatening conditions, but they do lead to increased risk of serious fractures. That’s why physicians at Novant Health UVA Health System Prince William Medical Center and Haymarket Medical Center encourage patients at heightened risk to undergo a dual-energy X-ray absorptiometry (DXA) bone mineral density screening.

DXA machines aren’t new technology, but they provide a lot of value to medical providers who want to evaluate their patients’ risk of bone fractures.

One of these providers is Jey Maran, MD, a medical oncologist at Cancer Center at Lake Manassas, a Novant Health UVA Health System facility. As an oncologist, Dr. Maran works with patients whose cancer treatments may require medications which can weaken bones or cause loss of bone mineral density. Access to DXA screening technology at both centers allows him to measure his patients’ bone density without referring them to an outside facility.

“There is a very effective breast cancer treatment, for example, that involves aromatase inhibitors. An unfortunate side effect can be loss of bone mineral density,” says Dr. Maran. “We make sure to take a baseline bone density measurement when we start patients on a treatment plan. From there, we follow up after two years to determine if there have been any changes and adjust the plan as needed.”

But why is measuring bone mineral density so important?

About bone mineral density

Bone mineral density is a measurement of bone thinness and risk of fracture. Physicians’ recommendations depend on age, body composition, health history and certain lifestyle factors, but there isn’t necessarily a specific age range or demographic that should be screened. However, there are populations more prone to osteopenia or osteoporosis including:

  • post-menopausal women
  • tall, thin women
  • people with chronic kidney or parathyroid conditions
  • patients on long-term medication plans
  • smokers
  • those with a family history of either osteopenia or osteoporosis

Density is reported in T-scores, which show how a patient’s bone density compares to that of an average, healthy adult. As the mean, the bone density of an average, healthy adult has a T-score of zero. The risk of bone fracture increases with every standard deviation below zero. A T-score of -1.0 or higher is considered normal, -1.0 to -2.5 indicates low bone density or osteopenia, and below -2.5 serves as a diagnosis of osteoporosis.

DXA Screenings

A DXA machine uses a low-dose X-ray to determine the thickness and density of a bone through a painless and noninvasive screening which lasts between 15 and 20 minutes.

A traditional X-ray machine is able to look at bones but does not offer standardization like the DXA machine does. DXAs standardize a patients’ bone health to their demographics’ averages and determine a T-score to quantify the amount of bone density lost between screenings. For the populations listed above, it is a valuable resource for measuring changes to bone density over time.

However, DXA machines can also be valuable tools for determining the cause of a traumatic fracture in otherwise healthy populations.

“If a patient has had a wrist fracture from a fall, physicians can use bone density assessments to determine whether osteoporosis or osteopenia could have contributed to the fracture, rather than just the trauma of the fall itself,” says Dr. Maran.

Before and During the Screening

A DXA screening and preparation is simple — patients may eat and drink normally the day prior and are only asked to avoid taking any calcium supplements that may affect the results.

The exam itself is done in two parts: one to assess the spine and one to assess the hips. The spine scan requires patients to lie flat on their backs with their legs elevated. The hip scan asks patients to outstretch their legs. For both parts, the detector portion of the machine slowly passes over the assessed area but does not make direct contact with the body.

The radiologist then reviews the exam images and reports results back to the patient’s ordering physician.

Treatment Options for Osteopenia and Osteoporosis

If a DXA screening results in a T-score within osteopenia or osteoporosis range, the good news is that these conditions alone don’t cause pain or discomfort. However, they do put patients at higher risk for fractures, which come with pain and long recoveries.

For either diagnosis, Dr. Maran recommends calcium and vitamin D supplements along with incorporating weight-bearing exercises to help strengthen the bones. Osteoporosis may also require a prescription medication.

For more information visit nhuvaimaging.com 

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