When should I be tested for osteoporosis? Will my tests be covered by insurance?

The National Osteoporosis Foundation recommends bone mineral density (BMD) testing on the following individuals:

• If you are a woman aged 65 or older or a man aged 70 or older, you should be tested for osteoporosis even if you have no other risk factors.

• If you are a postmenopausal woman under age 65 or a man aged 50 to 70, and you have clinical risk factors that put you at risk for bone loss or fractures, you should be tested. Generally, risk factors include the following (also see Questions 12 and 13):

Fractures in adulthood (especially after age 50)

Low-trauma fractures

Family history of osteoporosis

Genetic factors

Sedentary lifestyle

Nutritional deficiencies

Excessive alcohol, soda, or caffeine intake

Cigarette smoking

Low body weight or body mass index (BMI) below 22

Certain medications (especially steroids; see Question 15)

Low testosterone levels in men

Amenorrhea (no menstrual periods) from excessive exercise

Hormonal imbalances (prior to menopause)

Anorexia nervosa

Certain medical conditions (see Question 16)

• If you are a postmenopausal woman and have recently stopped taking estrogen, you should be tested.

• If you are a woman experiencing the menopause transition and have specific risk factors that are associated with a higher risk for fracture, such as low weight, use of a high-risk medication, or previous low-trauma fracture, you should be tested.

• If you are a man or a woman who had a fracture when you were over age 50, you should be tested.

• If you are a woman or a man with a medical condition (e.g., arthritis) or are taking a medication (e.g., corticosteroid at 5 mg or more per day for 3 months or more) that is associated with bone loss or low bone mass, you should be tested.

• If you are considering taking medication for osteoporosis, you should be tested.

• If you are being treated for osteoporosis, you should be tested to monitor how well the treatment is working.

• If knowing that you have bone loss would prompt you to use therapy, you should be tested.

You will note that several of the above recommendations refer specifically to men. Male patients and their clinicians should discuss their risk factors for osteoporosis, just as women should. Screening for bone loss is important for both women and men. Insurance coverage for testing of both men and women varies by insurance company. However, Medicare does cover bone density testing for those 65 or older who:

• Have vertebral abnormalities (e.g., a hump or severe curvature)

• Are estrogen-deficient (postmenopausal) women with a clinical risk for osteoporosis

• Take or plan to take long-term glucocorticoid therapy (5 mg or more per day for 3 or more months)

• Have primary hyperparathyroidism (overproduction of parathyroid hormone interferes with bone development)

• Are being monitored for effects of or response to approved osteoporosis treatments (see Part 3)

Testing may be repeated every 2 years, if you have Medicare. If you have medical coverage other than Medicare, you should check the guidelines for retesting with your insurance company.

Mark's comment:

I had ulcerative colitis for many years, and I was treated with steroids to control the diarrhea and bleeding. My nurse practitioner always talked to me about exercise, calcium, and vitamin D to make sure I protected my bones as much as possible. She also sent me for a bone density test. The people at the testing place were surprised—they said she was really paying attention and that it was unusual but really good that she sent me to get tested. They said bone loss happens too often to guys like me, but that most clinicians don't think to test for it. I guess I am one of the lucky ones because my bones were OK—but my nurse practitioner still tested me every few years and made sure I was getting enough calcium. Now I don't take steroids anymore at all—I had surgery and they removed the part of the colon that caused my problems. I am so glad it is better, and that my bones are OK. I feel like I have my life ahead of me. I'm only 48, so keeping my bones strong now is really important.

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