'BALLYHOOING' FOR BONE DENSITY TESTING 

By Sue Hoye

CNN

June 18, 1999

Osteoporosis, a disease that affects millions of women each year, is gaining public attention. In the past year, the importance of bone density testing has been brought to the forefront by both advocacy groups and legislative changes.

A national coalition of 110 organizations has put together a public awareness campaign called "Stay Strong! Test Your Bone Strength." The project aims to raise women's awareness of the disease and let them know that testing is easy, affordable and available.

Project spokeswoman, actress Debbie Reynolds, traveled to several cities across the nation as part of the educational campaign.

"We've been ballyhooing and trying to talk about the bone density test, because our doctors don't seem to be pushing this enough with the women. And it is vital that the ladies get the knowledge of it themselves and ask for the test themselves," Reynolds said.

In 1998, Congress mandated Medicare cover bone density testing. "Just like mammography, we essentially have a preventive health care test that Medicare is mandated to cover," said Dr. Robert Lindsay, president of the National Osteoporosis Foundation (NOF).

NOF is co-convener, along with OWL: The Voice of Midlife and Older Women, of Strong Women Inside & Out, the coalition sponsoring the education project.

Osteoporosis is a disease of the skeleton caused by an imbalance in the body's bone-rebuilding cycle, resulting in bone loss. It is defined as a bone density that is lower than the range for young adults (age 18).

Because losing bone is completely without symptoms, it is possible a person may already have osteoporosis by bone density criteria and not be aware of it.

REYNOLDS TAKES ON SPOKESWOMAN ROLE

Best known for her roles in "Singin' in the Rain," "The Unsinkable Molly Brown" and the more recent "Mother" and "In and Out," the veteran performer said she didn't know much about the disease when she was first approached about being an osteoporosis spokeswoman.

To learn more, Reynolds was asked to take a bone density test. The results surprised the 66-year-old actress.

"Mine showed a great deal of bone loss. I was really surprised. I'm very active physically. I'm a dancer for 51 years. I swim. I'm a vegetarian. I really lead a life that you would never expect that I would have this condition, even though my mother and my grandmother experienced it," Reynolds said.

Nearly 29 million Americans, 80 percent of them women, are affected by osteoporosis. Menopause is one of the greatest risk factors for developing the disease. The loss of estrogen that occurs during menopause can lead to rapid bone loss.

Reynolds' mother died just over a month ago from what Reynolds said was a decline starting with a fall that fractured her arms. "They feel it did come from being menopausal, because her bones wouldn't heal," Reynolds said.

Her grandmother too suffered from osteoporosis, and treatment was not as available then.

"My grandmother was about 4'8" and she dropped to being about 4'3". She was very small. As the years went by her back kept fracturing.... She was all bent over and she was in a lot of pain. It was quite painful, and they had no kind of medicine at that time, though now they do," said Reynolds.

For her part, Reynolds said she has already scheduled more testing, and her doctors will be letting her know soon what approach she should take to strengthen her bones. "Whatever it is, I will do it," she said.

THE PREVENTABLE, CURABLE DISEASE

With medications, behavioral modifications and dietary supplementation, it is possible to prevent osteoporosis and even reverse its affects.

"Even with severe osteoporosis and proper approach, which is individualized for the woman, you can rebuild bone," said rheumatologist Carolyn Smith.

In late 1998, NOF issued the first national guidelines for bone density testing and treatment.

The national recommendations grew out of a cost effectiveness analysis that took into account the cost of the disease, which is mostly the cost of fractures, as compared to the costs of diagnosis and intervention.

"And out of that analysis came the conclusions that it is cost-effective for women, by the time they reach 65, all to have had a bone density evaluation," said Lindsay.

The NOF suggests women under 65 who are post-menopausal should talk to their doctors about a bone density test if they also have multiple risk factors.

Risk factors are defined by the NOF as: a personal history of a fracture after age 40; family history of osteoporatic fractures; low body weight (less than 127 pounds); alcoholism; and cigarette consumption.

A QUICK AND PAINLESS TEST

When measuring bone density, Lindsay said, testing on the hip is preferable.

"Measurements of the hip predict a risk of hip fracture better than measurements at any other site and actually predict hip fracture better than cholesterol predicts the risk of a heart attack," he said.

By all accounts the test is simple and takes only about 10 to 20 minutes. A patient lies down on a table and machine passes a small amount of x-ray through the body. How thin the bone is is determined by how much of the x-ray gets through.

Besides the hip bone density test, there are tests that measure the spine, the heel or even the finger. "They are all quick, safe, reliable and certainly not painful at all," Smith said.

Bone densities are measured in t-scores. If a person has a +1 t-score, she has above-average bone density.

According to Lindsay, the NOF found it was more cost-effective to consider pharmacological intervention in women who have a -2 t-score and no risk factors except being post-menopausal and being female.

For women with other risk factors, pharmacological intervention should be considered at a -1.5 t-score.

The standard drug treatment doctors are using is hormone replacement therapy, but other pharmacological options are also available.

The disease ranges in severity. Clinical osteoporosis, or severe osteoporosis, exists when a patient has low bone density and fractures.

"So someone who has had a fracture, whether it be a spine fracture, wrist fracture or hip fracture, and who has low bone density, would be considered to have severe disease," Lindsay said.

While the NOF is strongly recommending testing for older women, Lindsay said it really is not useful for younger women.

"We do not recommend bone density testing for women before menopause unless they have no periods; then there is a good reason," Lindsay said.

OSTEOPOROSIS NOT LIMITED TO WOMEN

Men may also get osteoporosis. Although they don't have the estrogen difficulty that women do, as men age, they lose bone mineral density.

While some studies have said up to 5 million men have the disease, there is still no good way to grade men. "We know what their bone density is. We can measure the absolute number, but we don't have an equivalent of a t-score for men," Lindsay said.