Who Should Get a Bone Density Test in Ajax?

Is a bone density test something you should be asking about, or is it something for “later”? It is a fair question, and one we hear often from patients in Ajax, Pickering and Whitby. Bone loss is quiet. It does not cause pain on its own, it does not show up in the mirror, and many people only learn their bones have thinned after a fall that seemed far too minor to break anything.

A bone mineral density (BMD) test is one of the simplest ways to get an objective picture of bone strength before that happens. This guide walks through who is commonly referred for the scan, the risk factors doctors weigh, what the test actually measures and how to prepare if your health-care provider decides it is right for you.

Before going further, one practical note: at Rossland Diagnostic Clinic in Ajax, a bone mineral density scan requires a physician’s referral. The decision about whether and when you need one belongs with your family doctor or nurse practitioner. The goal of this article is to help you have a better-informed conversation with them.

A quick self-check before your next appointment

You do not need to diagnose yourself, but it can help to walk into your next check-up having thought about a few questions. Consider whether any of the following apply to you:

• You are 65 or older.
• You have gone through menopause, particularly if it happened early.
• You have broken a bone from a simple fall or a minor bump as an adult.
• A parent broke a hip.
• You have taken steroid medications such as prednisone for an extended period.
• You have a condition that affects how your body absorbs nutrients or uses hormones.
• You have noticed you are shorter than you used to be, or your posture has changed.
• You smoke, or you drink alcohol regularly in larger amounts.
• You have a low body weight or have lost a noticeable amount of weight.

If you checked one or more of these, it does not mean anything is wrong. It simply means bone health is a reasonable topic to raise with your health-care provider.

Why bone density matters at all

Bone is living tissue. Throughout life, your body is constantly breaking down small amounts of old bone and building new bone in its place. In early adulthood, building usually keeps pace with or outpaces breakdown, and most people reach their peak bone mass sometime in their late twenties or thirties.

After that, the balance gradually shifts. For many women, bone loss speeds up in the years around and after menopause because of falling estrogen levels. Men lose bone too, typically more slowly, which is one reason osteoporosis in men is often overlooked.

When bones become thin and more porous, they are more likely to break. The fractures most associated with osteoporosis are those of the hip, spine and wrist. A spinal fracture may not even be obvious at first; some people notice only back discomfort, a gradual loss of height or a forward curve in the upper back.

The point of measuring bone density is not to create worry. It is to find out early enough that you and your doctor can make thoughtful decisions about lifestyle, fall prevention and, when appropriate, treatment.

Who is commonly referred for a BMD scan

Canadian guidance on bone health generally focuses on age and risk factors together rather than on any single item. Your doctor will look at your whole picture, but the groups below are the ones most often discussed.

Adults aged 65 and older

Age is one of the strongest risk factors for low bone density. For this reason, bone density testing is widely recommended for women and men from about age 65, even when they feel perfectly well. Many people in this age group have never had a scan, and a first test gives a useful baseline.

Adults between 50 and 64 with risk factors

Being in your fifties or early sixties does not, on its own, usually prompt a scan. But when it is combined with other risk factors, your doctor may suggest testing sooner. Common examples include:

• a fracture after age 40 from a low-impact event, such as falling from standing height
• a parent who had a hip fracture
• long-term use of glucocorticoid (steroid) medication
• certain other medications that can affect bone, such as some hormone therapies used in breast or prostate cancer care
• early menopause
• smoking or high alcohol intake
• low body weight or significant weight loss

Younger adults with specific medical conditions

Some conditions can affect bone at any age. These include rheumatoid arthritis, celiac disease and other conditions that affect nutrient absorption, some hormone disorders, and certain kidney or liver conditions. Long periods of very low body weight, such as with an eating disorder, can also affect bone. If you live with one of these conditions, your specialist or family doctor may consider whether a bone density scan is appropriate.

People already being treated or monitored

A BMD test is not a one-time event for everyone. If you have been diagnosed with low bone density or osteoporosis, or you are taking a medication that affects bone, your doctor may order repeat scans to see how your bones are changing over time. How often this happens is a medical decision based on your individual situation.

What about athletes?

Bone density testing is sometimes used outside of osteoporosis care. Some athletes, particularly those in sports where low body weight is emphasized, use BMD results to better understand their overall body and bone health. As with any scan at the clinic, a referral is still required.

What the test actually measures

A bone mineral density scan uses an enhanced form of low-energy X-ray to estimate how much calcium and other minerals are packed into a section of bone. The areas most commonly measured are the lower spine and the hip, because those are important sites for fractures and give a good overall sense of bone health.

The results are usually reported as scores that compare your bone density to two reference groups:

1. A healthy young adult reference. This comparison shows how your bones measure up against peak bone mass. It is the comparison most often used when describing normal bone density, low bone mass (sometimes called osteopenia) or osteoporosis.
2. People of your own age and sex. This comparison helps your doctor see whether your bone density is about what would be expected for your age, or lower.

Bone density is only one part of the picture. Many doctors combine your BMD results with other information, such as your age, past fractures, medications and family history, to estimate your overall fracture risk over the coming years. That combined assessment is what guides next steps, so the numbers on the report are best interpreted together with your doctor rather than on their own.

What the scan is like

For many people, the biggest surprise is how easy the scan is. There are no needles, no injections and nothing to swallow. You lie on a padded table while a scanning arm passes slowly over the area being measured. You will be asked to stay still for short periods, but you can breathe normally, and there is nothing to feel.

Because a BMD scan uses low-energy X-ray, the radiation exposure is very low, generally described as a small fraction of what is used in many standard X-ray examinations. If you are pregnant or think you might be, tell your doctor and the clinic team before your appointment.

The scan is painless and non-invasive, and most people are on and off the table in a short visit.

How to prepare for your appointment

A little preparation helps the test go smoothly and keeps your results accurate.

• Skip calcium and iron supplements on the day of your scan. Do not take calcium supplements or iron tablets on the day of your examination until after your scan is done. You can take them afterwards as usual.
• Dress without metal. Wear clothing without zippers, metal buttons, snaps or underwire where possible. Metal fasteners in the scanning area can interfere with the measurement. Comfortable, elastic-waist clothing works well.
• Bring your documents. Bring your health card and the requisition from your doctor.
• Mention recent imaging. If you have recently had a test that used contrast dye or a barium study, let the team know when you book, since some materials can affect results.
• Share your history. If you have had previous BMD scans elsewhere, mentioning it can help your doctor compare results over time.

Our clinic is on the ground floor at 300 Rossland Road East in Ajax, with free parking, which many of our older patients appreciate.

Common questions

Do I need a referral for a bone density test? Yes. At Rossland Diagnostic Clinic, a physician’s referral and requisition are required for a bone mineral density scan.

Is a bone density test the same as a regular X-ray? Both use X-ray technology, but they serve different purposes. A standard digital X-ray produces a picture of bones and other structures and can show a fracture. A BMD scan measures bone mineral content to estimate bone strength. A regular X-ray is not designed to measure bone density accurately.

I feel fine. Why would I need one? That is exactly the reason the test exists. Bone loss usually causes no symptoms until a fracture happens. A scan can pick up thinning bones while you still feel completely well.

How will I get my results? Your results are sent to the doctor who referred you. They will review them with you and discuss whether anything needs to change.

Should men be tested too? Men can and do develop osteoporosis. Many of the same risk factors apply, and men aged 65 and older, or younger men with risk factors, are often good candidates to discuss testing with their doctor.

Starting the conversation

If you are not sure whether a bone density test is right for you, the best first step is a simple question at your next check-up: “Should I have my bone density measured?” Bring the self-check list above if it helps. Your doctor can weigh your age, health history and medications and decide whether a referral makes sense now or later.

If you already have a requisition, you are welcome to book your scan with our Ajax team. Call us at 905-426-3111 or request an appointment online. We are open Monday to Friday from 9:00am to 5:00pm and Saturday from 8:00am to 3:30pm, and our team is happy to answer any questions about preparing for your scan.