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BONE DENSITY TEST FOR OSTEOPOROSIS SHOULD BE GIVEN

BETWEEN AGES 21 AND 35

CHICAGO -- With more than 28 million Americans at high risk for osteoporosis, radiology researchers today warned that most women receive bone density tests too late to give them the best chance to prevent the disabling disease.

More than two-thirds of Americans who have or are at risk for osteoporosis are women, but many don't undergo densitometry tests to measure how brittle their bones are until they reach menopause. Ideally, women with significant risk factors would receive a baseline radiologic-based test between ages 21 and 35 when the body is still building bone and lifestyle changes can do the most good, according to information presented at the 84th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA).

"We are trying to eradicate osteoporosis within the next century, but the key is to find it early and prevent it," said David J. Sartoris, M.D., professor of radiology and director of bone densitometry, University of California at San Diego School of Medicine. "Women at risk are wasting 20 years of potential intervention by waiting until menopause to find the disease." Osteoporosis is a disease in which the bones become thinner, or more brittle, and are more likely to break. More than 10 million Americans have been diagnosed with osteoporosis, and the disease results in 1.5 million fractures annually, according to the National Osteoporosis Foundation. It's likely that two-thirds of American women are osteopenic, meaning their bones are weaker than they should be, and are at risk for developing the disease, according to Dr. Sartoris.

Risk factors include being female, being Caucasian or Asian, being thin or underweight, having a family history of osteoporosis, being anorexic or not having regular menstrual periods.

"An abnormal bone density test should prompt people to change their lifestyle," said Christopher Cann, Ph.D., adjunct professor of radiology, University of California at San Francisco. Dr. Cann is a panelist with Dr. Sartoris at a special focus session on osteoporosis during the RSNA meeting. "When your bones are brittle, they can't support normal daily function anymore. You may be able to walk around, perhaps even exercise, but you might pick up a heavy grocery bag and get a compression fracture in the spine."

The most commonly used tests for osteoporosis are:

peripheral, typically an ultrasound or X-ray test that measures the bones of the forearm, heel, shinbone, toes or fingers; and

central, which measures either the spine or hip, or total body calcium. The two most common central tests are quantitative computed tomography (QCT) and dual energy X-ray absorptiometry (DXA). According to radiologists, both types of tests have their place.

"Osteoporosis typically starts in the central skeleton and later affects peripheral sites, so in the early stages, a woman could have osteoporosis in her spine or hip that won't show up on a peripheral test," said Dr. Sartoris. "Peripheral tests are most appropriate for older women." "The central tests definitely are better, but the peripheral tests are inexpensive, five-minute exams that can reach a larger segment of the population," said Dr. Cann. "A peripheral test can still show a decrease in bone mass even if it hasn't reached the osteoporosis stage, and, along with a clinical history, can help determine if the person should have a central test and seek treatment."

Typically, after having a bone densitometry test, a woman will receive one of four diagnoses:

Normal. The skeletal system is as strong as that of a young, normal individual.

Osteopenia. Skeletal bone density is 10 to 25 percent below peak mass, and the person is at risk for osteoporosis.

Osteoporosis. Skeletal bone density is 25 percent or more below peak mass.

Established osteoporosis, which is osteoporosis with fragility fracture. Skeletal bone density is 25 percent or more below peak bone mass, and the person has had an inappropriate fracture, typically in the spine, hip or forearm. Treatment varies, depending on the diagnosis.

"Five years ago, there was no treatment, but now there are a lot of options," said Dr. Cann. Women who are diagnosed with osteoporosis will typically be prescribed one of the following, all of which curb bone loss:

calcitonin, a synthetic version of a hormone made by the thyroid gland;

Fosamax(r) (alendronate sodium), a bisphosphonate, which is similar to a naturally occurring chemical in the body that plays a role in suppressing bone breakdown. Other bisphosphonas are currently being considered for FDA approval.

hormone replacement therapy; or

Evista(r) (raloxifene), a selective estrogen receptor modulator (SERM), which is a designer estrogen without some of the side effects of hormone replacement therapy. Evista(r) is the only SERM currently available, although several others are in the approval process. The latter two are appropriate only for menopausal or post-menopausal women.

Women who are diagnosed with osteopenia should ensure they get enough daily calcium and vitamin D, exercise, stop smoking and avoid excessive alcohol or caffeine. They may also be placed on hormone replacement therapy or a SERM, or given a lower dose of Fosamax(r), according to Dr. Sartoris.

"We don't yet have an FDA-approved bone builder, but several are in the testing stages, and one should be available in the near future," said Dr. Sartoris. The real answer is preventing osteoporosis.

"We're starting to think of osteoporosis not as a disease of older women, but as a pediatric disease, because that's when the problem frequently starts," said Dr. Sartoris. "Most children and adolescents don't get nearly enough calcium or physical activity. Many young girls diet and are underweight or develop eating disorders. They're already in trouble by age 30."

The RSNA is an association of 30,000 radiologists and physicists in medicine dedicated to education and research in the science of radiology. The Society's headquarters are located at 820 Jorie Blvd., Oak Brook, Illinois 60523-2251.

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Copies of 1998 RSNA news releases are available online at http://www.pcipr.com/rsna beginning Monday, Nov. 30.