A bone density test for osteoporosis should be as routine for women over age 65 as mammograms are now, according to Victoria endocrinologist Lucretia van den Berg.

"It's important because we're all getting older," says the physician, explaining that with age bones thin, increasing the risk of osteoporosis and low-trauma fractures. This process starts about a decade later in men than in women, whose bone-thickening estrogen declines with menopause.

Fractures from osteoporosis are three times more common in women than heart attacks, seven times more common than strokes and 10 times more frequent than breast cancer, van den Berg says.
 

The test is an imaging technique using a very low dose of radiation to measure bone density for the diagnosis of osteoporosis. It is non-invasive and takes under 20 minutes to screen both the spine and hip, says van den Berg.

Van den Berg believes every woman should have the test early in menopause as a baseline to measure any future decrease in bone density. However, the B.C. Medical Services Plan (MSP)

doesn't cover the test except in certain circumstances, such as a family history of osteoporosis, presence of compression and low-trauma fractures, and early (pre-45) menopause.

Only comparatively recently has MSP expanded the criteria to include women over 65, a change some physicians say is not widely known.

General physician George Sayad was shocked on moving here in 2005 to find that the test was not covered for all women over 65 as it was when he practised in Ontario.

"It should be routine for any woman over 65," he says. "At 65 the bone density is less than at 50."

He argues that the test, estimated to cost about $200, is cheaper than treating someone with undiagnosed osteoporosis who falls, breaks a hip and needs hospitalization.

"I think it has been determined to be cost-effective," says Sayad.

A health ministry spokesperson says the change to include all women over 65 was implemented in 2005. The new requisition forms only became available late last year.

This left physicians such as Sayad to rely on the old forms, which did not list women over 65 among those qualifying for the free test.

"It doesn't help if they change the criteria and don't send out new forms," says Sayad. "Unless it's on the form, you're not going to remember."

Physicians are inundated with paperwork, so any changes announced by MSP are easy to miss, he says.

The widespread testing of women over 65 now means fewer undiagnosed cases of osteoporosis, van den Berg says. Many women suffer what she terms "silent" compression fractures. They are unaware of the fracture and consequently at greater risk for medical complications.

Compression fractures in the spine are uncomfortable and, ultimately, cause stooping, which leads to respiratory complications. The altered posture can also prompt falls, van den Berg says.


Source : Times Colonist (Victoria) 2007