Bone Density Screenings are a Practice Necessity

Written by on November 1, 2011 in Features, Practice tips - No comments
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By Ashley Acornley, R.D., L.D.N.

Adding bone density screenings with the Dual-Energy X-Ray Absorptiometry (DEXA), the most widely used bone mineral density test for the spine and hip, is smart business for your practice. Savvy physicians realize that with more screenings, patients are more likely to stay with a practice and use more offered diagnostic interventions, plus patient volume will increase when the practice is known as a health care site of choice within the community.

The physicians who offer bone screenings include women’s health clinics, primary care physicians as well as specialists such as gynecologists, radiologists, rheumatologists, clinical endocrinologists. Women’s clinics who offer bone density screenings as well as mammography screenings recognize that these patients overlap and that they all want a one-stop shop to save their time and money. Another plus is that revenue can be boosted in these clinics without the burden of hiring additional staff since mammographers, nurses and RTs can be trained to perform the DEXA test.

According to the National Institute of Health (NIH), females are at greater risk for low bone mass, fractures and osteoporosis than males. Remind patients that every woman begins losing bone mass after the age of 30, and bone loss continues to accelerate after menopause. Health practitioners can help female patients learn the risks for osteoporosis so they can incorporate appropriate lifestyle changes to live a fuller, healthier life.

Benefits of offering the DEXA Screening Tool

The DEXA screening tool can identify bone loss by as little as two percent in one year which is necessary for diagnosis since there are no obvious symptoms of low bone mass. In comparison, a traditional X-ray machine would be unable to spot a change in bone mass unless it had deteriorated 20 to 30 percent. It concentrates its reading on the spine and hip, which are the two most prone areas for fractures. After the patient lies down on the examining table, the DEXA scans two X-ray beams with two different energy levels at the patient’s bones. After the soft tissue is subtracted, the bone mineral density (BMD) can be seen. The DEXA is non-invasive and requires very little preparation from the patient, plus it is a quick test. The average patient throughput time is 20 minutes. The test itself costs around $200 with Medicare covering the test in all 50 states and the District of Columbia. The Health Care Financing Administration covers the DEXA test once every two years and will cover additional tests when medically necessary. Medicare and insurance company reimbursement covers the test under CPT codes 77080, 77081, 76977, 77078, 77082.

When bone mass declines

In addition to the DEXA tool physicians can use other screening tools and education in their practices in order to identify bone loss in females at an earlier stage and counsel them with strategies to prevent rapid deterioration of the bone, including diet and exercise. The U.S. Preventive Services Task Force recently issued new recommendations for bone mass screening with a risk profile tool called the WHO Fracture Risk Assessment Tool (FRAX). The Task Force suggests screening for all women older than 65, and also for younger women who have a high risk profile. The FRAX helps predict an individual’s risk of bone fracture over the next 10 years and takes into consideration several risk factors, including age, race, smoking, diet, activity, medications, and age of menopause.

According to Dr. Susan Fisher, a graduate level nutrition professor at Meredith College in Raleigh, N.C., a female’s peak bone mass is accrued from the onset of adolescence until about 28 years old. Approximately 45 percent of bone is formed during this growth stage, so the need for calcium and Vitamin D is particularly important at this time. Dr. Fisher states that after the late 20s, “Bone mineral density slowly declines until menopause, and bone loss accelerates for approximately five years after this phase.” Bone becomes less dense and weaker over time due to a lack of estrogen in the body, which causes calcium to be removed and not fully replaced from the bones. Therefore, if a woman hasn’t built strong, dense bones by the time she is in her late twenties, she risks having weak, brittle bones in the future. This can increase the risk for fractures, broken bones, and the diagnosis of osteoporosis later on in life.

Recommendations for Your Patients

Exercise

Remind your patients to

  • Build bone through weight-bearing exercises. Chad Golding, a NASM Certified Personal Trainer and boxing instructor residing in Raleigh, N.C., states, “Bone is our support system for working muscles and is the living tissue that responds to increased tension and work by building and repairing new cells quicker than living cells die, therefore increasing bone density.”
  • For the lower body: walk with hand weights, do jumping jacks, hike and dance
  • For the upper body: use free weights or resistance bands can help improve the upper body.
  • Yoga, tai chi, and Pilates can help increase bone density and improve strength, balance, and coordination, which can reduce risk of falls and fractures.
  • If injured, swimming is a great workout that builds strength and is easy on the joints. To avoid injury when starting an exercise plan, it is best to work with a personal trainer or physical therapist that works with specialized populations.

Nutrition

Remind your patients to

  • Get plenty of calcium in their diets through yogurt, milk, cheese, salmon, tofu, almonds, spinach, broccoli, and kale. Lactose intolerant women can include soy beverages and fortified orange juice in their diets as well. Taking a supplement can help if a woman’s calcium intake is inadequate. As of 2010 the Institute of Medicine recommends teenage girls ages 13-18 get 1,300 mg/day of calcium, while adults ages 19-51 require 1,000 mg/day. For women aged 51 and older, the RDA is 1,200 mg/day.
  • Get plenty of Vitamin D in their diet by spending 5-15 minutes daily in sunlight and consuming rich sources such as dairy, eggs, salmon, sardines, and tuna. If dietary intake or sun exposure is low, a supplement is recommended. Recommend a limited intake of salt, alcohol, caffeine, and soft drinks, as they can weaken bones over time when consumed in excess. The current RDA for adults is 600 IU/day, the equivalent of two cups of milk.

Who should be tested?

Before testing with the DEXA, women need to be aware of their risk factors for having low bone mass. These include being a woman, increased age, small frame, ethnicity, family history, and sex hormones. Older females of white or Asian ethnicity have the greatest risk for low bone mass. As do small, thin-framed women who have infrequent menstrual cycles and estrogen loss due to menopause.  However, there are many behaviors that women can change, such as smoking, a sedentary lifestyle, medication use, consuming excess alcoholic beverages, and having a diet low in calcium and Vitamin D.  If women find that they have at least three of these risk factors above, they are most vulnerable to fractures and osteoporosis.

Although osteoporosis involves many risk factors that women cannot control, research shows that there are many lifestyle changes females can make to keep their bones healthy. It is important that physicians stress the importance that females over the age of 35 receive a proper bone density screening to identify the symptoms of low bone mass or osteoporosis at an early stage. Doctors should encourage their female patients to schedule an annual visit to discuss the risks of low bone mass, and ways to prevent this from occurring. This includes reviewing current diet, exercise regimen, and calcium and Vitamin D supplement use. If the patient has an increased number of risk factors, a DEXA screening once every two years should be recommended. More bone screenings are desirable for female patients, and savvy practices should implement these screening tools into their business to demonstrate value and quality of care, which will in turn increase traffic and revenue.

Ashley Acornley, R.D., L.D.N.
Ashley is originally from Philadelphia, PA and earned her Bachelor of Science degree in Nutritional Sciences with a minor in Kinesiology from Penn State University in August 2008. She completed her Dietetic Internship at Meredith College in Raleigh, NC in May 2010 and is currently working on completing her Master’s Degree in Nutrition. Ashley is also an AFAA certified personal trainer and has been training clients for the past four years. She enjoys staying active by participating in 5Ks, triathlons, and other competitive events. She also practices boxing, yoga, and strength training at her local gym. Besides physical activity, Ashley has found a new interest for cooking, baking, and visiting the local farmer’s markets in Raleigh. Ashley is especially interested in wellness and sports dietetics and enjoys teaching her clients how to stay healthy, motivated, and physically active! Ashley’s blog, “Fresh From the Farm,” can be found at: http://www.ashleyfreshfromthefarm.wordpress.com.

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