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Hrt: how can you tell if you have osteoporosis? HRT: HOW CAN YOU TELL IF YOU HAVE OSTEOPOROSIS?
Imagine you are quietly going about your normal life, when suddenly you trip and fall. You stretch out a hand to save yourself, and the next thing you know you have fractured your wrist. Unfortunately, most Accident and Emergency doctors are so busy that they just don't have time to explain that your Colles' fracture is probably caused by osteoporosis, even less to explain what you might do about it. An X-ray will have shown up the fracture, but osteoporosis does not show up on an ordinary X-ray until one-quarter or more of the bone density has been lost, so if you have lost less than that so far the chances are that no one will notice that die cause of your fracture was osteoporosis, let alone tell you about it, and what you can do to stop it getting worse. A Colles' fracture should be seen as a warning sign about die state of your bones, while still giving you time to do something about it.
Sudden or severe backache in the years after the menopause can have many causes, and it may not occur to your doctor that osteoporosis could be the cause in your case. He may arrange an X-ray (which doesn't show anything wrong), possibly physiotherapy, probably painkillers, but eventually you get the message that you will 'just have to learn to live with it'.
It needn't be like that. Dual energy X-ray absorptiome-termachines, known as DEXA (or DXA) for short, are the best way to screen bones for osteoporosis, and are now becoming available all over the country, both on the NHS and privately. DEXA scanning is quite painless, and involves no undressing or embarrassment. DEXA machines scan your hip and spine, and produce a reading of your bone density, which will give a good idea of whether or not you have got osteoporosis, how severe it is, and what your chances are of getting a fracture; the lower your bone density, the more likely you are to sustain a fracture. Bone mineral density at the time of the menopause is the best predictor of osteoporosis, so in an ideal world, all women who are at risk of developing this disease would have a DEXA bone scan when they reached the menopause, and if their bone density was lower than it should be they would be advised on ways of reducing their chances of getting a fracture, including information on HRT. Until this happy day comes, don't ignore any back pain you get, or a Colles' fracture of the wrist, or loss of height - ask your doctor about osteoporosis.
You may see advertisements offering private screening for osteoporosis, and if this is on a DEXA bone scanner and will scan your hip and vertebrae, the reading will give your doctor a clear idea of your bone density and therefore of how likely you are to develop osteoporosis. Some companies are jumping on the osteoporosis bandwagon and offering screening that is less reliable; if you are in any doubt, ask your doctor. As a general rule, the only way to tell what the bone density is in your hip is to scan the hip, and the same with the vertebrae; scanning other parts of the body (such as the heel and wrist) does not give a truly accurate impression of your bone density in the important hip and spine areas. However, such a scan will show if your bone density is very low or very high; it's those people in the middle who will need more precise measurement.
Scanning poses a difficult dilemma for the National Health Service. To scan all post-menopausal women would be prohibitively expensive, and large-scale dials have shown that it is not cost-effective to do this. To scan all women who are at risk of developing osteoporosis is still expensive, but if it can reduce the number of osteoporotic fractures (which currently cost the NHS over ?600 million a year) by identifying women who have a low bone density and offering them treatment, such as HRT, to reduce their chance of having a hip fracture, then considerable savings can be made. On the other hand, if millions of women take HRT for many years, that, too, is very expensive.
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