Battle for the bones

synapse: University of Nevada, Reno School of Medicine

Tina Hailer positions a woman's forearm for bone density scanning

Tina Hailer, DXA technician, positions a woman's forearm for bone density scanning. Photo by Laura Levin

Tucked in the office spaces of the internal medicine department in Reno, the Center for Bone Health offers testing to help combat and prevent the onslaught of osteoporosis.

Story by Anne McMillin, APR

While usually observed in those over age 50 and post-menopausal women, men and even children may also develop osteoporosis either due to side effects of some medications or an underlying disease.

Osteoporosis, a debilitating disease in which bones become fragile over time and likely to fracture due to loss of mineral density in the skeleton, affects four times more women than men, according to the National Osteoporosis Foundation, which estimates nearly 44 million Americans are affected. If not prevented, or left untreated, it can progress unnoticed until a bone breaks, typically in the hip, spine or wrist and lead to severe pain, hospitalization, surgery, permanent disability or death.

Physicians and technicians (all certified by the International Society for Clinical Densitometry) at the School of Medicine's Center for Bone Health screen and measure a patient's bone mineral density using dual energy X-ray absorptiometry, or DXA, technology considered the gold standard test in clinical practice, to arrive at a prediction for the likelihood of a fracture to occur over time.

"Our understanding of bone health is fairly recent due to the increasing elderly population base and our recognition of the impact of fractures on the elderly," said John Pixley, M.D., a board certified rheumatologist and certified clinical densitometrist with the internal medicine department. He also serves as the Center for Bone Health's medical director.

"This DXA diagnostic and screening tool allows us to identify patients at risk and/or those with undiagnosed contributing factors such as unrecognized diseases or contributing therapies. This helps the treating physician know when to institute therapy, look for undiagnosed causes and monitor patient progress," said Pixley.

A patient for bone density testing presents upon referral from a primary care physician or specialist.

Tina Hailer, DXA technologist at the center, takes the patient’s medical history to determine risk factors for osteoporosis including having a small frame or build, being of Caucasian or Asian ethnicity, being a postmenopausal female, having a low calcium diet, smoking, taking certain medications or physical inactivity. She will also take the patient’s height and weight measurements for comparison.

The fully clothed patient then lies motionless (except for normal breathing) on a table while the DXA takes images from above and below along the length of the body, concentrating on the hip, spine and forearm. The procedure takes approximately 15 minutes.

Hailer generates a "fracture index" report from the DXA scan, which predicts the probability of a fracture occurring within 10 years, compared with people in their 20s and age-matched controls.
The report, which is interpreted by a qualified physician in the department, also includes criteria for treatment which may include exercise, change of diet, pills, daily injections or an annual intravenous drip.

"Our reading of the fracture index report includes criteria for treatment, that we pass along to the primary care physician who made the referral," Pixley said.

The procedure, which costs about $200, according to Pixley, is repeated 18 to 24 months later for a comparison to see the patient's progression over time.

Hailer said part of her job involves patient education.

"I tell them what foods have vitamin D or how to get more calcium, either through diet or pills. I also talk about fall prevention so they can avoid falling, which may lead to fractures."

She said helping patients understand the importance of exercise, which promotes bone growth as old bone cells are broken down by physical activity then regenerated, is key for osteoporosis prevention and recovery.

Pixley said he sees great value in having this technology at hand for use on his patients at the center.

“Endocrinologists and rheumatologists use the DXA technology for their patients because the medications we use or diseases we treat can accelerate the development of osteoporosis. Physicians who use medications that predispose patients to develop osteoporosis should be using this procedure as well," Pixley said.

According to Pixley, several challenges lie in the path of getting more patients to the Center for Bone Health for low bone density testing.

"There seems to be a lack of third party interest in this technology," he said. "The medical societies also need to state a stronger case for the value of the DXA test performed by properly qualified physicians and technicians."

Insurance companies are often reluctant to pay certified centers to perform this inexpensive test, Pixley added.

The Center for Bone Health is located in the internal medicine offices at 1500 East Second Street, Suite 302 in Reno.