You are past menopause, a fair amount of weight has come off, and your sister broke a wrist last year falling from standing height. Nothing in your own body is going to raise the subject: bone thins without pain, and for most people the first sign of it is a break. There are two things to get out of it: a scan you can ask for by name, and a daily amount for calcium and for the vitamin that lets you absorb it. Take four facts about yourself to whoever handles your regular care and you can settle both at one appointment.
Yes, bone comes off alongside the weight, at the hip in particular. Whether a scan gets ordered for you turns on your age and on a short list of facts about you; before 65 it is the list that decides, not the weight change. The scan is a central DXA. Your sister's wrist is not on that list and a parent's broken hip is, which is the one thing worth checking before you go.
What the weight coming off does to bone
Bone comes down with the weight at two places in particular: the total hip, and the femoral neck, the narrow stretch at the top of the thigh bone. In adults with overweight and obesity, weight lost through dieting lowered bone density at both of those and left the lumbar spine unchanged. Adding exercise to the diet held back part of the femoral neck loss and none of the loss at the hip, the spine or the wrist. Everyone in those trials was dieting, so what they describe is weight coming off rather than any one way of taking it off.
Two things about eating sit on the risk list for osteoporosis, next to the ones nobody can change. One is a diet low in calcium and vitamin D, which raises the risk of both osteoporosis and fractures. The other is eating too little for too long, or getting too little protein, and that one is still in your hands while the weight is coming off. Eating enough when your appetite has gone quiet is its own problem with its own amounts, and the training that keeps hold of muscle is two sessions a week.
What puts you on the list for a scan before 65
The recommendation names five among the facts that decide it for a postmenopausal woman under 65 — menopausal status, low body weight, a parent's history of hip fracture, cigarette smoking and heavy drinking — and says they are examples rather than the whole set. A clinician weighs those into a fracture-risk assessment, and the scan is recommended when that assessment comes back raised. At 65 every woman is in scope whatever the five say. For men, the same recommendation says the evidence is not there to call it either way.
Your sister's wrist is not among the five, and a parent's hip is — so the question to answer before the appointment is what your mother's or father's bones did, not your sister's. A sibling's fracture is still worth saying out loud. It is a different fact, and it goes in as a different fact.
The test itself is a central dual energy x-ray absorptiometry, written DXA or DEXA, and it measures the hip and the spine because those are the bones that break. A peripheral version measures the wrist, fingers, leg or heel, and those are the smaller machines found in pharmacies, shopping centers and at health fairs. The screening recommendation is not written about that one. What comes back for a woman past menopause is a T-score.
| T-score | What it means |
|---|---|
| –1 or higher | Healthy bone |
| –1 to –2.5 | Osteopenia, a less severe form of low bone density |
| –2.5 or lower | Osteoporosis may be present |
A T-score compares your bone density against that of a healthy young adult, and the risk of a break rises by one and a half to two times with every one-point drop. Before menopause, or for a man under 50, the number that comes back is a Z-score instead, which compares you against people your own age.
The person who can order one
The page that explains the numbers puts the scan in your doctor's hands and names no specialty, so the person to ask is the one who already orders your tests. What you are asking that person for is a central DXA of the hip and spine, and then for the T-score itself when it comes back.
The second ask has two numbers behind it. Women aged 51 to 70 need 1,200 mg of calcium a day, and adults up to 70 need 600 IU of vitamin D, which is what lets the calcium be absorbed. People with obesity, and people who have had gastric bypass surgery, are among those named as needing extra vitamin D. Whether your own eating reaches either number is something a clinician can work through with you in a few minutes.
Two things do not wait for an appointment. Sudden severe back pain, a loss of height, or a newly stooped posture are the symptoms NIAMS names for a fracture in the spine, and they belong with your clinician rather than in a waiting list. A suspected broken bone in the hip, pelvis or upper leg is on the 911 list, and so is a fall after which the person cannot be moved.
The four facts to bring
- Say how much weight has come off and over what stretch of time, and what you weigh now.
- Say whether either parent broke a hip or was ever told they had osteoporosis.
- Say whether you smoke, and how much you drink in a week.
- Say when your periods stopped.
- Then ask for a central DXA of the hip and spine, and ask for the T-score itself rather than a word for it.
- Ask what your eating covers of the calcium and vitamin D amounts, and what to add if it falls short.
Bone is the one thing here you cannot check by feel, and a T-score is what gets measured instead, at an ordinary appointment, by an ordinary clinician. Before 65 it gets ordered because somebody asked out loud, and in that room the only person who can ask is you.
