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American Medicine

Osteoporosis is more common as people grow older

Osteoporosis is a common complication of aging, and produces high risk of fractures, which cause disability and even death.  Osteoporosis can be effectively treated. When doctors discover osteoporosis and prescribe treatments, the risk of fractures is reduced by 30 to 50%.

Sometimes, doctors neglect to screen for osteoporosis. The usual type of screening is a bone density or DEXA scan. However, many individuals have chest or abdomen CT scans performed for other problems.  And now we know that such scans can give patients the opportunity to find out if they have osteoporosis.

A recent study was performed (P. Pickhardt and co-authors, Annals of Internal Medicine 2013, Volume 158, Page 588), which showed that osteoporosis can be adequately evaluated during conventional CT scans of the chest or abdomen.  Simply having the radiologist examine the lumbar spine for bone mineral density was able to reliably detect osteoporosis in patients.

In usual radiology practice, about 30% of CT scans report incidental findings, two-thirds of which are considered important.  However, in the physician’s office, only about half of the important incidental findings are ever followed up by the doctor.  So, important findings on your CT scan may be overlooked by your doctor, and information about bone health may be overlooked by the radiologist.

Because of this, individuals who are getting CT scans should follow up with their physicians about abnormalities on the CT scans.  And patients should request that doctors order a check of the lumbar spine for osteoporosis when a CT is ordered.

Here are my tips for you:

• If you are having a CT scan of the chest or a CT scan of the abdomen, request that the radiologist evaluate the lumbar spine for bone mineral density to detect osteopenia or osteoporosis.
• Follow up with your physician (primary care physician or specialist) to determine if there were incidental findings on the CT scan and to determine what your bone mineral density was found to be.
• Get a copy of the CT scan report to make certain that the bone mineral density was evaluated and to be certain if your physician has followed up on any incidental findings.
• If you are confused about the wording on the CT scan report, or are not sure if incidental findings were discovered, be certain to ask your physician.
• If your physician will not adequately describe incidental findings to you, consider getting a second opinion.

For more information on communicating with your physician and getting second opinions, see my book, “Surviving American Medicine.”