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Dr. Gregory Pais, ND
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“Cost-effectiveness of Bone Densitometry Followed by Treatment of Osteoporosis in Older Men”, JAMA. 2007;298:629-637

It has been the standard approach for the last 10-20 years to recommend bone densitometry scanning (dual-energy x-ray absorptiometry or DEXA) for older women as the best diagnostic test for osteoporosis. In the Aug. 8 2007 issue of the Journal of the American Medical Association (JAMA) it’s suggested that this should be done for older men as well. In other words, men get osteoporosis, too.

According to this article men who are 65 years old and older who have already fractured a bone should get the screening, as should all men who are over 80. It’s estimated that one in four Caucasian men will suffer an osteoporosis-related broken bone at some time in their lifetime compared to one in two women. Twenty percent of people die the year following a hip fracture due to complications from surgery. Men are more likely to die from complications of their fractures than women.

DEXA scans often cost $300 or more. And many insurance plans do not cover this test. Even though the diagnostic accuracy of this test is much more specific for osteoporosis than say mammograms are for breast cancer. Even with a close family history of osteoporosis I’ve seen women struggle to have their DEXA scans covered.

An additional test to consider, and one that costs 100’s of dollars less (and does not expose you to radiation like the DEXA), is the blood test for vitamin D—serum hydroxy vitamin D. Lack of vitamin D is closely associated with risk of osteoporosis. If possible I recommend the vitamin D test and a DEXA scan. When the proper vitamin D test is done we then have the ability to supplement appropriately, based on the results. This provides an excellent nutritional component in an osteoporosis treatment plan.

Earlier this year when I was in Boulder, Colorado for the National Center for Homeopathy annual conference I went to the local hospital lab to get a Vitamin D test. It’s easy to do there, as you don’t need a physician’s order to get common blood work. In fact, they give you a discount for being a self-pay patient. The optimum range for Vit. D is estimated to be at least 40-60 mg/nL. My result was 24 mg/nL.

Consequently, for the first time in almost 15 years I am taking a nutrition supplement regularly. Even though I spend a fair amount of time in the sun in the summer and winter I know that it’s not enough in this part of Pennsylvania. And we are discovering that even people in much sunnier climates, getting what should be more than adequate exposure, are low in vitamin D.


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