Osteoporosis is called a ‘silent disease’ for a reason: it produces no symptoms until a fracture occurs. The fracture itself, often of the hip, spine, or wrist, may be the first indication that bone density has declined to a point of significant risk. For older adults, particularly women, a hip fracture carries life-altering consequences: up to 30% of hip fracture patients die within one year of the fracture, and many who survive experience permanent loss of independence.
Bone density testing can identify osteoporosis and significant bone loss before fracture occurs, making it one of the most important preventive screenings in geriatric care. At Dr. Maryam Khan’s practice in Lutherville-Timonium, MD, osteoporosis screening is incorporated into routine preventive care for appropriate patients.
What Is Osteoporosis?
Bone is living tissue that is continuously remodeled: old bone is broken down (resorption) and new bone is formed. In early adulthood, bone formation exceeds resorption, and bone density peaks around age 30. After that, the balance gradually shifts toward resorption. In women, this process accelerates significantly after menopause due to the loss of estrogen, which plays a protective role in bone metabolism.
Osteoporosis occurs when bone density and bone quality decline to the point where fracture risk is substantially elevated. Osteopenia is the intermediate stage, bone density below normal but not yet meeting the threshold for osteoporosis.
Who Should Be Screened?
U.S. Preventive Services Task Force (USPSTF) recommendations guide osteoporosis screening in Dr. Khan’s practice:
• All women aged 65 and older: Routine bone density testing with DEXA scan is recommended regardless of other risk factors.
• Postmenopausal women under 65 with elevated fracture risk: Screening is recommended earlier when risk factors are present. The FRAX tool (Fracture Risk Assessment Tool) calculates 10-year fracture probability based on age, sex, BMI, family history, and other factors.
• Men aged 70 and older with risk factors: Evidence for routine screening in men is less robust, but men with significant risk factors, long-term steroid use, hypogonadism, prior fracture, significant weight loss, warrant evaluation.
Risk factors that accelerate bone loss and lower the screening threshold include:
• Early menopause (before age 45)
• Long-term use of glucocorticoids (prednisone and related medications)
• Rheumatoid arthritis
• Malabsorptive conditions (celiac disease, inflammatory bowel disease)
• Smoking and heavy alcohol use
• Low body weight (BMI below 18.5)
• Prior fragility fracture in adulthood
• Parental history of hip fracture
What Is a DEXA Scan and What to Expect
The gold standard for bone density measurement is Dual-Energy X-ray Absorptiometry (DEXA). The procedure is simple, quick, and involves very low radiation, far less than a standard chest X-ray:
• Duration: Approximately 10 to 20 minutes
• What happens: You lie on a padded table. A scanner arm passes over your body. You do not need to undress, but should avoid clothing with metal buttons or zippers at the scan sites.
• Sites measured: Typically the lumbar spine and hip, which are the most clinically relevant sites for fracture risk.
• No injection or contrast: DEXA does not involve any needles or contrast agents.
Understanding DEXA Results: T-Scores and Z-Scores
| T-Score Range | Interpretation | Clinical Category |
| Above -1.0 | Bone density within normal range for young adults | Normal |
| -1.0 to -2.4 | Bone density below normal but above osteoporosis threshold | Osteopenia |
| -2.5 or below | Bone density meets criteria for osteoporosis | Osteoporosis |
The Z-score compares bone density to age-matched peers rather than young adults and is more relevant in premenopausal women and men under 50. A Z-score significantly below zero in a younger patient warrants evaluation for secondary causes of bone loss.
Treatment: What Happens After a Low Score
Calcium and Vitamin D
Adequate calcium and vitamin D are foundational to bone health. Most older adults do not get sufficient vitamin D from diet and sun exposure. Dr. Khan assesses vitamin D levels and provides supplementation guidance tailored to each patient. The recommended daily calcium intake for women over 50 is 1,200 mg from food and supplements combined. Supplemental calcium should be taken in divided doses for optimal absorption.
Pharmacological Treatment
For patients with osteoporosis or very high fracture risk, pharmacological treatment reduces fracture risk significantly. First-line agents are bisphosphonates, alendronate (Fosamax), risedronate (Actonel), and zoledronic acid (Reclast, given by IV infusion annually). These medications inhibit bone resorption and have demonstrated 30 to 50% reduction in vertebral and hip fracture risk in clinical trials.
For patients who cannot tolerate bisphosphonates, or who have very high fracture risk, alternatives include denosumab (Prolia, a biologic given by injection every six months), romosozumab (an anabolic agent), and teriparatide (a parathyroid hormone analogue). Dr. Khan selects treatment based on the degree of bone loss, kidney function, prior fracture history, and patient preference.
Weight-Bearing Exercise
Weight-bearing exercise, walking, dancing, resistance training, stimulates bone formation. It is a complementary strategy alongside pharmacological treatment and supplementation, not a substitute for pharmacotherapy in confirmed osteoporosis.
How Often Is Rescreening Needed?
For women with normal bone density at age 65, rescreening every 15 years is typically sufficient. For women with osteopenia, rescreening every 2 to 5 years is appropriate depending on the degree of bone loss. For patients on treatment for osteoporosis, bone density is typically rechecked at 2-year intervals to assess treatment response.
| To discuss osteoporosis screening or bone health at your next visit, contact Dr. Maryam Khan, MD at (443) 577-4010. Located at 1205 York Rd, Suite 11, Lutherville-Timonium, MD 21093. Serving Timonium, Towson, Cockeysville, and Baltimore County. |