So, you've had a bone mineral density test, and now you have your results. But what do these results actually mean?

Likely your results are from a test referred to as a "DEXA", the abbreviation for dual x-ray absorptiometry test, which uses x-rays.

Your "DEXA" did not truly measure bone mineral density as such, but rather measured the amount of calcium, which is a surrogate marker for bone density, and is therefore less accurate, particularly in elderly patients. What this means to you is that bone mineral density results are diagnostic guides only and not treatment thresholds. In other words, the results are one factor only to be taken into account in determining a course of action.

Nonetheless, the standard of practice for doctors requires them to prescribe certain drugs if your tests are below a certain range. This score had been a BMD score of minus 2.5 or more. However, recently the World Health Organization changed that to minus2.0, a difference that opens up a whole new category of patients for whom the standard of practice requires doctors to prescribe these drugs.

This is the state of affairs despite the fact that bone mineral density test results do not correlate directly with the health of bone. "Ideally," states J. C. Prior of the Division of Endocrinology and Metabolism at the University of British Columbia, the results of such tests "should be shown to correlate with the ashed mineral content of the bone, to parallel the tensile strength of bone, and predict the fracture frequency. None of the reported measurements can yet meet all these criteria."

Indeed, according to J. E. Compston, Dept. of Medicine, University of Cambridge, some studies report that large increases in bone mass as seen in bone mineral density studies may actually be associated with a reduced bone strength and unchanged or increasing fracture rates!

In fact, recent studies "indicate that fracture prevention is not necessarily associated with increase in bone density." Truly healthy bones are not only dense, they are also flexible, supple and strong as a result of healthy microarchitecture.

BMD tests don't measure these characteristics, which correlate more with fracture rates than density. Bones that appear to be dense can actually be unhealthy, - brittle, rigid and prone to breakage.

Some medical treatments currently prescribed to treat osteoporosis actually cause bones to become more dense, therefore appearing to be"healthy" in BMD measurements. But in fact, they have become more dense and brittle, and therefore more prone to fracture. To be truly healthy, bones must be both supple and dense.

If you wanted to have a great score on your bone mineral density test, you could drink some lead - NOT recommended! Still, t the lead would be taken up by your bones, causing your test scores to rise. Of course, you'd also become confused, lose your memory, develop seizures, coma and then die.

The point is that bone mineral density tests are not perfect. They measure only one half of the health bone picture, which is bone density and entirely eliminate the other half, which is suppleness. And even if bones show up as dense, no one knows why they're dense, whether because they have great mineral content, or because they took up some heavy metal that makes them look good but actually means they contain substances that are profoundly toxic to the human body.

So use them as one indicator only in making your decision about how to improve and protect your bone health.

Pamela Levin, R.N.
June 17, 2011

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