Should I get a bone density test?

Patient

Q: I just would like to know if I should ask my VA doctor for a bone scan, I don't want to ask for something I don't need, but my back and joint pain has gotten difficult to tolerate, and constant. My mother just told me she was diagnosed with osteoporosis at age 35. I snap, crackle, pop, and click in my neck, back, especially lower back, and hips when I move. I have broken every toe except one big toe, most of them multiple times. Chiropractic does not seem to help. Is a bone scan justified?

Doctor

A:   I think it will be more reasonable if you request for a spine xray first. There are certain conditions that would predispose an individual to osteoporosis. These are called risk factors; in osteoporosis, these are: current cigarette smoking, low body weight (<58kg), estrogen deficiency (early menopause < 45 y.o., irregular menses with no period for > 1 year), low calcium intake, poor health, excessive alcohol intake, inadequate physical activity, those who were on drugs such as steroids, anti-seizure drugs, heparin, lithium, etc. There are also other conditions that will result to osteoporosis e.g. hyperparathyroidism, type 1 Diabetes mellitus. Perhaps, your mother had at least one of these risk factors or perhaps one of these conditions that’s probably why she was diagnosed with osteoporosis at such an early age. With your case, the more important thing for you to do is try to cut down your alcohol intake. Most fractures associated with osteoporosis are on the hips and vertebra (spine). An xray can also detect the density of these bones and will give a clue if you do have osteopenia or osteoporosis. Your doctor might agree with doing a spine xray first; if it does show some vertebral fractures or bones appear less dense, a bone scan would be reasonable. It is noteworthy that a bone mass density test involves radiation; too much radiation is also not good since it can cause certain cancers. I do hope I have answered your question and take care always.

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