Bones [01] Bone Density™: Who Should Consider It and Why?"

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Bones [01] Bone Density is a helpful concept for describing bone mineral density, a useful measurement of the amount of mineral in bone tissue. Bone density is not constant across the lifespan, and low bone density may make fractures more likely. But a bone density number does not provide the complete picture of skeletal health.

This guide explains how bone mineral density is measured, what DXA results and T-scores mean, nutrients and exercises that aid bone health, and key considerations. It also covers frequently asked questions about a 1.7 result and if it’s good, which vitamin is most important, what is a concerning bone-density score, and if a T-score can get better.

What Is Bones [01] Bone Density?

Bones [01] Bone density is the amount of minerals, especially calcium and phosphorus, in bone tissue. Dense bone usually offers greater structural support. Decreased bone mineral density to a significant degree can contribute to fracture risk. Bone is living tissue that is constantly being remodeled as old bone is taken away and new bone is built up.

The most common clinical measurement is a dual-energy X-ray absorptiometry (DXA) test. The hip and spine are commonly evaluated areas of assessment of fracture risk, often measured by the central DXA. The test is generally quick, minimally invasive and has a relatively limited radiation exposure. Bone density measurements can be used to identify osteoporosis, to detect density that is below normal, and to monitor changes that occur during treatment.

Bones [01] Don't confuse Bone Density with the broader quality of bone. Bone strength is also affected by other factors, including bone structure and turnover, geometry, falls, muscle strength, medications, age, and medical conditions. As such, a single number should be evaluated in the light of an individual’s overall fracture risk, and not as a comprehensive measure of skeletal health.

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How Does Bone [01] Density Operate?

Bones [01] Bone Density is determined by the balance between bone formation and bone resorption that is occurring. Specialized cells remove older bone while other cells produce new tissue. Bone formation during childhood and early adulthood usually exceeds bone loss and bone mass increases. As we age, this balance can be shifted toward losing more bone, especially after menopause and with other conditions that change hormone levels or bone metabolism.

A DXA scan delivers a measurement of bone mineral density and routinely reports a T-score and, when appropriate, a Z-score. The T-score compares the measured bone density with the average density of a healthy young-adult reference population . It is applied to post-menopausal women and men 50 years and older . Generally a T-score of -1 or higher is considered healthy. A score from -1 to -2.5 is within the osteopenia range, and a score of -2.5 or lower is in the range associated with osteoporosis.

Bones [01] The testing site, equipment, position and normal variability in the measurement may also impact the Bone Density results. In younger adults, premenopausal women, and children, clinicians more often emphasize the Z-score, which evaluates bone density to an age- and sex-matched reference population. That's why you can't just focus on one number when you're looking at a report.

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Bones [01] Bone Density Benefits

Well-maintained Bones [01] Bone Density helps provide the mineralized framework to support the body and protect organs. Adequate bone density is related to increased skeletal tissue and may be associated with decreased fracture risk. Healthy bones also work with muscles to help support movement, posture and physical activity.

Weight-bearing and resistance exercise may assist in maintaining or improve aspects of skeletal health. Brisk walking, climbing stairs, dancing, resistance band exercises and strength training place appropriate mechanical stress to bones. Exercise can also improve muscle strength and balance, which can help lower the risk of falling. However, those with osteoporosis or a history of fractures may need an individualized exercise program, as some high-impact movements can raise the risk of injury.

Normal bone maintenance relies on adequate calcium, vitamin D, protein and overall nutrition. Calcium is an important structural mineral and vitamin D contributes to the absorption of calcium. Good nutrition is valuable, but more than the recommended amount of supplements will not give you stronger bones and may even produce the opposite effect.

It could also mean reducing factors that accelerate bone loss to maintain skeletal health. Smoking, heavy alcohol use, prolonged inactivity, some medications, hormonal changes, and some medical conditions can all affect skeletal health. While it may be important to target a particular underlying factor, not all causes of low density can be improved by lifestyle measures alone.

Bones [01] Risks and Side Effects of Bone Density

Bones [01] Bone Density is not a clinical intervention or medication and it has no side effects. The risk, if any, would arise from how the bone density is measured or treated. A DXA scan is a low dose x-ray, and the body is exposed to a small amount of radiation. Peripheral screening devices may be used in some settings but do not necessarily produce the same diagnostic information as central DXA of the hip and spine.

Supplements also need to be used at appropriate doses. Some people can have digestive symptoms such as constipation with calcium supplements and too much calcium can be potentially problematic for some people. Vitamin D supplements are potentially beneficial when diet or blood levels are low, but too much can result in vitamin D toxicity and increased calcium levels. Therefore, by default, supplements should be a complement of a well-rounded diet, not a replacement.

In the right patients, prescription drugs for osteoporosis can help reduce the risk of fracture, but each drug has its own potential side effects and contraindications. The decision to treat is determined from bone density, history of fractures, age and other risk factors and medical conditions. However, a lower T-score does not automatically mean that medication is necessary for every person. And just as a relatively normal score doesn't exclude every possible risk of fracture.

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Who Needs Bones [01] Bone Density?

Because Bone [01] Bone Density is a measurement and not a product, the more useful question is, Who should be evaluated with bone-density testing? Current routine screening guidelines in the United States are aimed at women 65 years of age and older and younger postmenopausal women with sufficient risk of fracture. Testing may also be advised if a clinician identifies other risk factors for bone loss or fracture .

Low bone density can also be present in men and younger people. Risk factors include a prior fracture, long-term use of certain drugs like glucocorticoids, low body weight, hormonal problems, malabsorption syndromes, smoking, heavy drinking, and a family history of osteoporosis or hip fracture. The appropriate testing strategy will depend according to age and individual circumstances.

People with osteoporosis or osteopenia may undergo follow-up DXA testing to track changes. However, repeat testing at very short intervals is not necessarily informative because changes in bone density can be small and may be part of normal measurement variation. The timing of follow-up testing is usually determined individually.

Bones [01] Bone Density Relative to Other Bone Health Tests

[01] Bones Bone Density testing is different from other ways of examining bone health. Bone mineral density is commonly measured at the hip and spine using central DXA, and other areas such as the wrist or heel are measured using peripheral tests. Quantitative ultrasound offers some information on bone properties but cannot serve as a substitute for central DXA for the diagnosis of osteoporosis.

Bone-density tests are not like blood tests, either. Blood tests can identify vitamin D deficiency, abnormalities in calcium, thyroid problems, kidney problems or other conditions that can cause bone loss but do not directly assess bone mineral density. When investigating unexplained low bone density, a clinician may combine several types of information.

Lifestyle strategies are another important complement or complement to testing and treatment. Exercise, good nutrition, not smoking, drinking alcohol responsibly, fall prevention and appropriate medical care can all contribute to improving bone health. These measures promote the skeleton but should not serve as a replacement for prescribed treatment for osteoporosis where there is a high risk of fracture.

Where to Get Bones [01] US Bone Density

Bone mineral density testing is widely available in the United States through hospitals, medical centers, imaging facilities, and other healthcare organizations that perform DXA services. Depending on the facility and the patient’s situation, testing may be prescribed by a physician or other qualified health care professional. Insurance coverage and eligibility can vary, so it’s best to check pricing before scheduling a scan.

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A healthcare professional can help assess whether central DXA or another type of testing or lab evaluation—or no testing at this time—is needed. The results should be understood according to age, sex, fracture history, medications, medical conditions and other risk factors, not judged on the numerical value alone.

Frequently Asked Questions About Bones [01] Bone Density

What is a normal bone density?

A single bone-density value of 1.7 is not enough to label it as normal or abnormal. DXA reports are normally interpreted using T-scores or Z-scores. The importance of a raw BMD value is affected by the measurement site, scanner, reference population, and other factors. 1.7 is T-score or 1.7 g/cm^2 ? If it is T-score it is a distinct interpretation. The interpretation requires the full set of measurements.

What vitamin is helpful for building bone density?

No single vitamin has been shown to rebuild bone density in everybody. Vitamin D is especially important because it helps the body absorb calcium and maintain normal bone metabolism. But healthy bones also need enough calcium, protein and other nutrients. Correcting a vitamin D deficiency may improve your bones, but taking high doses when you don’t have a deficiency won’t necessarily raise bone density and could do harm.

What is considered a concerning bone density score?

In postmenopausal women and men age 50 or older, a T-score between -1 and -2.5 is usually considered osteopenia. A T-score of -2.5 or lower is in the osteoporosis range. Lower scores usually mean lower bone mineral density and a higher risk of fracture. However, treatment decisions also factor in fracture history, age, medications, and other clinical risk factors.

Can I improve my T-score for bone density?

In some cases, bone density may be maintained enough to improve or maintain a T score. Bone health can be supported by resistant and weight bearing exercise, adequate calcium and vitamin D, sufficient protein intake, avoidance of smoking and appropriate medical treatment. However, changes may be slow, and some people are mainly interested in preserving existing bone density rather than seeing a big increase in density.

What is a usual bone density T score?

A T-score of -1 or above is usually described as normal for populations in which T-scores are used. It's not that there are no fractures, or that the bone qualities are all normal. Risk of fracture is also related to age, previous fractures, medications, falls, medical conditions and other factors that may not be accounted for by the T-score.

Osteoporosis and osteopenia are distinct conditions, but they are related.

Not at all. Osteopenia is a low bone mineral density (BMD) that is below the normal range but not low enough to meet the definition of osteoporosis by DXA. A T-score between -1 and -2.5 is generally in the osteopenia range and -2.5 or lower is in the osteoporosis range. Osteopenia can still be related to significant fracture risk, especially in the presence of other factors.

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Here are some foods that are good for supporting bone density:

Calcium, vitamin D, protein and other nutrients in foods can contribute to maintaining normal bones. Examples include dairy products, calcium-fortified foods, calcium-fortified tofu, some greens, fish, eggs and other nutrient-dense foods. Food choices should be appropriate for the person’s total dietary needs. Nutrition alone will not be sufficient for managing established osteoporosis or significantly increased risk of fracture.

Does walking help build bone?

Walking is a weight-bearing exercise that may help preserve bone health and physical function. It may help preserve bone and is most effective when integrated with resistance and balance exercises. The effect on bone mineral density, however, is affected by age, fitness, skeletal site and exercise intensity. So, walking should be regarded as one component of a comprehensive bone-health strategy, not as a sure-fire way to improve a T-score.

How often should I get a bone-density test?

There is no single recommended interval for testing. The follow-up DXA testing is guided by the initial result, age, fracture risk, treatment status and other clinical factors. The measurement variability of DXA makes too frequent testing hard to interpret for small changes. The health care professional can determine the appropriate interval between tests based on the reason for testing and the individual’s risk profile.

Vitamin D alone can’t increase bone density.

Vitamin D is required for absorption of calcium and for normal skeletal function, especially in the individual with deficient vitamin D. However, vitamin D alone is not a panacea for low bone density. Adequate calcium, protein, physical activity and management of underlying medical conditions are also important. Combination of prescription treatment with nutrition and lifestyle measures may be necessary for osteoporosis.

[01] Bone Density A Final Look at Bone Health

Bones [01] Bone density is best viewed as a starting point when talking about bone mineral density, testing and fracture risk than as one treatment or a sure-fire way to strengthen bones. DXA testing may deliver useful measurements, but T-scores have to be assessed according to age, sex, testing site, medical history and other risk factors.

Good nutrition, the right kind of physical activity, steps to prevent falls, not smoking or drinking too much alcohol, and medical treatment when needed are usually important for good bone health. Bone density changes are incremental and fracture risk is individual, so it’s more useful to take a broader view than one number or one nutrient.