Diagnosis and Treatment        Print this page

Questions to ask your doctor
DEXA scan
Diet and Lifestyle tips
The Value of Calcium
Some common medical treatments

After completing the risk assessment questionnaire on this website, you may wish to take it to your doctor and discuss each of your risk factors. In addition you could ask your doctor the following questions:

• Am I at risk of osteoporosis?
• How can I limit my risk and prevent osteoporosis?
• Are any of the medications I am currently taking putting me at a higher risk of developing osteoporosis?
• Should I be referred for a DEXA scan? If so, where would this be conducted and how long am I likely to have to wait for an appointment?
• Am I getting enough calcium and/or vitamin D from my diet?
• Should I be doing some weight bearing exercise?
• If I was diagnosed with osteoporosis or osteopenia (early stage of the disease), what treatments are available that could protect and rebuild my bones?

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DEXA Scans

If your doctor considers that you may be at risk, he/she may refer you for a DEXA (Dual Energy X-ray Absorptiometry) scan, a special X-ray which determines bone density.

This is a fast, accurate and painless procedure where you lie fully clothed on a padded examination table. It takes only 15 minutes to scan the lumbar (lower) spine and the hip, and uses an extremely low dose of radiation.

DEXA scans are usually performed in a hospital setting; private clinics and some GP surgeries also have DEXA scanners.

Scan results are compared to peak bone mass (normal bone density in healthy men and women aged between 23 and 35). This result is called a T-score. In general the lower your T-score and bone density, the higher your risk of fractures.

NORMAL: a T-score value greater than -1 means that your bone density is normal and you do not have osteoporosis

OSTEOPENIA: a T-score value of between -1 and -2.5 indicates osteopenia, which is the state of bone health prior to osteoporosis

OSTEOPOROSIS: a T-score value less than -2.5 indicates osteoporosis

Your doctor will assess whether you require a DEXA scan, depending upon your particular circumstances. Depending on the findings of your DEXA scan, you and your doctor can decide what treatment is right for you. Your doctor may recommend a follow-up DEXA scan in 18 months to two years to assess any changes in your bone health.

Reimbursement

Depending on your circumstances, a DEXA scan can cost around €100. You can, however, claim tax relief for medical expenses. You may be able to claim back part of the cost of the scan from your medical insurance company depending on the scheme you are covered under. Check your membership handbook or contact your insurer directly.


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Lifestyle Changes

5 key things that you can do now to improve your bone health

• Eat wisely – a diet that includes foods from each of the four food groups should provide you with good general nutrition. (1 = cereals, breads, potatoes, pasta, rice; 2 = fruit and vegetables; 3 = milk, cheese and yoghurt; 4 = meat, fish and alternatives)
  
  
• Adopt a diet rich in calcium and vitamin D –
  
  a. Calcium is the most abundant mineral found in our bones and helps to give them strength and rigidity so it is an important factor in maintaining healthy bones. Calcium rich foods include low fat milk, cheese and broccoli. How much you need depends on your diet, age and other health issues, so it is best to discuss this matter with your doctor.
  
  b. Vitamin D plays a vital role in bone health. Without vitamin D, calcium which is required for strong and healthy bones cannot be absorbed. The major source of vitamin D is from sunlight on the skin, so when your exposure to the sun is reduced you may need to find other sources of vitamin D. Unlike calcium, vitamin D is not readily available from diet. It is found naturally in only a small number of foods, including dark leafy vegetables, egg yolks, liver, oysters and oily fish. However, most normal diets do not contain enough vitamin D, so it often needs to be supplemented.
  
  
• Kick unhealthy habits - don’t smoke; avoid excessive alcohol intake and take caffeine in moderation.
  
  
• Exercise – Half an hour of physical activity most days of the week is what’s needed. If you have been inactive, start slowly. While swimming helps heart-fitness and keeps muscles mobile, it doesn’t strengthen bones. To benefit the bones it has to be weight-bearing exercise, such as walking. It’s simple, it’s free and the sun shining on your skin helps your body make vitamin D, which also benefits your bones. If the weather is bad, try dancing or slow skipping, indoors. Exercising in a group is helpful; you could consider learning Tai Chi or a similar gentle method of exercise which will help improve posture and avoid stress on your spine.
  
  
• Be aware – keep informed and be aware of the steps you can take to prevent the condition.
  

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The Value of Calcium

   

Weight		Food	Calcium (mg)
(oz)	(g)
1/3 pint	190ml glass	Full fat milk	224
1/3 pint	190ml glass	Skimmed milk	235
1/3 pint	190ml glass	Semi skimmed milk	231
1/3 pint	190ml glass	Soya milk	25
1/3 pint	190ml glass	Concentrated orange juice (unsweetened)	67
5	150	Yoghurt, low fat fruit	225
1	28	Cheddar Cheese	202
4	112	Cottage Cheese	82
1	28	Processed Cheese	168
3	84	Cheese omelette (1 egg, 1oz cheddar)	235
4	112	Cheese and tomato pizza	235
4	112	Ice cream	134
2	56	Milk chocolate	123
4	112	Spinach, boiled	179
4	112	Broccoli, boiled	45
4	112	Baked beans	59
4	112	Red kidney beans, cooked	80
3	84	Soya bean curd, steamed	428
2	56	Brazil nuts	95
2	56	Swiss style muesli	62
1 slice	30g	Bread, white	33
1 slice	30g	Bread, wholemeal	16

Some of the Common Medical Treatments

In addition to lifestyle and dietary recommendations, your doctor may recommend one of the following common treatments. Treatment depends on a number of factors including age and medical history.

For men and women:

• Calcium is the most abundant mineral found in our bones and helps to give them strength and rigidity so it is an important factor in maintaining healthy bones. Calcium rich foods include low fat milk, cheese and broccoli. How much you need depends on your diet, age and other health issues, so it is best to discuss this matter with your doctor.
  
  
• Vitamin D plays a vital role in bone health. Without vitamin D, calcium which is required for strong and healthy bones cannot be absorbed. The major source of vitamin D is from sunlight on the skin, so when your exposure to the sun is reduced you may need to find other sources of vitamin D. Unlike calcium, vitamin D is not readily available from diet. It is found naturally in only a small number of foods, including dark leafy vegetables, egg yolks, liver, oysters and oily fish. However, most normal diets do not contain enough vitamin D, so it often needs to be supplemented.
  
  
• Bisphosphonates are one of the most commonly prescribed treatments for osteoporosis. They work by decreasing bone turnover, which, in turn, increases bone mineral density (BMD), improves bone strength, and helps reduce the risk of fractures including those of the hip and spine. Available in daily, once weekly and monthly formulations. A formulation is also available which combines a bisphosphonate and vitamin D.
  

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For women only:

• Selective oestrogen receptor modulators (usually called SERMs) are drugs which help maintain bone density and reduce fracture rates, specifically at the spine. Available as a daily tablet.
  
  
• HRT (Hormone Replacement Therapy) is oestrogen replacement for women at the menopause, which helps maintain bone density and reduce fracture rates. However, because of research indicating that long term use may increase the risk of stroke, breast cancer and possibly heart disease, it is no longer regarded as a front-line option for the prevention or treatment of osteoporosis.
  
  
• Teriparatide stimulates the formation of new bone and has been demonstrated to reduce the incidence of vertebral, but not hip, fractures. It is available as a daily injection.
  
  
• Strontium is a treatment for postmenopausal osteoporosis to reduce the risk of vertebral and hip fractures. It is available in granule sachets for daily administration.

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For men only:

• Testosterone. Options for men are limited but, for those with low levels of testosterone, testosterone enhancement treatment may help maintain bone density.

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