• If you are a women aged 65 or older, you should be tested for osteoporosis even if you have no other risk factors.
• If you are under age 65, postmenopausal, and you have more than one risk factor (other than being white, postmenopausal, or female), you should be tested. Generally, risk factors include:
Low body weight or body mass index (BMI) below 22 Certain medications (especially steroids) Low testosterone levels in men Amenorrhea (no menstrual periods) from excessive exercise, eating disorders, or hormonal imbalances Hormonal imbalances (prior to menopause) Anorexia nervosa
Certain medical conditions (see Question 13).
• If you are postmenopausal with a recent fracture, you should also be tested.
You will note that few of the above recommendations refer specifically to men. Male patients and their clinicians should discuss their risk factors for osteoporosis, just as women should. Insurance coverage for testing of both men and women varies by insurance company. However, Medicare does cover bone density testing for those 65 or older who:
• have vertebral abnormalities (for example, a hump or severe curvature of the spine)
• are estrogen deficient (postmenopausal) women with a clinical risk for osteoporosis
• take, or plan to take, long-term glucocorticoid therapy
• have primary hyperparathyroidism (overproduction of parathyroid hormone interferes with bone development)
• are being monitored for effects of or response to approved osteoporosis treatments (see Part Three).
Testing may be repeated every two years, if you have Medicare. If you have medical coverage other than Medicare, you should check the guidelines for re-testing with your insurance company.
I had ulcerative colitis for many years, and I was treated with steroids to control the diarrhea and bleeding. My nurse practitioner always talked to me about exercise, calcium, and vitamin D to make sure I protected my bones as much as possible. She also sent me for a bone density test. The people at the testing place were surprised—they said she was really paying attention and that it was unusual but really good that she sent me to get tested. They said bone loss happens too often to guys like me, but that most clinicians don't think to test for it. I guess I am one of the lucky ones because my bones were OK—but my nurse practitioner still tested me every few years and made sure I was getting enough calcium. Now I dont take steroids anymore at all—I had surgery and they removed the part ofthe colon that caused my problems. I am so glad it is better, and that my bones are OK. I feel like I have my life ahead of me. I'm only 48, so keeping my bones strong now is really important.
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