Dr. Eck received a Bachelor of Science degree from the Catholic University of America in Biomedical Engineering, followed by a Master of Science degree in Biomedical Engineering from Marquette University. Following this he worked as a research engineer conducting spine biomechanics research. He then attended medical school at University of Health Sciences. He is board eligible in orthopaedic surgery.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Osteoporosis is a condition that is characterized by bones that are less dense than, and thus not as strong as, normal bone. Osteoporosis increases the risk of breaking bone (fracture) with even minor trauma, such as a fall from standing height, or even from a cough or sneeze. Unfortunately, people often do not realize they have osteoporosis until either they have a fracture or have a screening test ordered by their doctor to check for osteoporosis. Osteoporosis and low bone mass affect an estimated 44 million Americans (National Osteoporosis Foundation 2008). Of those, 10 million have osteoporosis, and the remaining 34 million have a lower than normal bone mass and are at higher risk of developing osteoporosis. Women are
four times more likely to develop osteoporosis than men. Other risk factors include older age, family history of osteoporosis, small and thin stature, inactive lifestyle, smoking, alcohol, and use of certain medications including steroids. The treatment and management of osteoporosis is discussed in detail elsewhere on this site. This article will focus on the role of bone mineral density (BMD) evaluation.
How does osteoporosis occur?
In order to understand the role of bone mineral density scanning, it is important to know a little about how osteoporosis occurs. Bone is constantly being remodeled. This is the natural, healthy state of continuous uptake of old bone (resorption) followed by the deposit of new bone. This turnover is important in keeping bones healthy and in repairing any minor damage that may occur with wear and tear. The cells that lay new bone down are called osteoblasts, and the cells responsible for resorption of old bone are called osteoclasts. Osteoporosis occurs as a result of a mismatch between osteoclast and osteoblast activity. This mismatch can be caused by many different disease states or hormonal changes. It is also commonly a result of aging, change in normal hormones as occurs after menopause, and with diets low in calcium and vitamin D. In osteoporosis, osteoclasts outperform osteoblasts so that more bone is taken up than is laid down. The result is a thinning of the bone with an accompanying loss in bone strength and a greater risk of fracture. A thinning bone results in a lower bone density or bone mass.
There are two major types of bone. Cancellous bone (also known as trabecular
bone) is the inner, softer portion of the bone, and cortical bone is the outer,
harder layer of bone. Cancellous bone undergoes turnover at a faster rate than cortical bone. As a result, if osteoclast and osteoblast activity become mismatched, cancellous bone is affected more rapidly than cortical bone. Certain areas in the body have a higher ratio of cancellous bone to cortical bone such as the spine (vertebrae), the wrist (distal radius) and the hips (femoral neck).
Most of a person's bone mass is achieved by early adulthood. After that time, the bone mass gradually decline throughout the rest of a person's life. There is a normal rate of decline in bone mass with age in both men and women. For women, in addition to age, the menopause transition itself causes an extra degree of bone loss. This bone loss is greatest in the first
three to six years after menopause. Women can lose up to 20% of the total bone mass during this time. Since women generally have a lower bone mass to begin with in comparison with men, the ultimate result is a higher risk of fracture in postmenopausal women as compared to men of the same age. Nevertheless, it is important to remember that men may also be at risk for osteoporosis, especially if they have certain illnesses, a low testosterone level, are smokers, take certain medications, or are sedentary. The best method to prevent osteoporosis is to achieve as high a bone mass by early adulthood with a proper diet and regular exercise. Unfortunately, osteoporosis is not often considered during this time in a person's life.
Melissa Conrad Stöppler, MD Medical Editor: William
C. Shiel Jr., MD, FACP, FACR
Bone density testing is used to assess the strength of
the bones and the probability of fracturein
persons at risk for osteoporosis. The test, referred to as bone densitometry or
bone mineral density scan (BMD), is a simple,
noninvasive procedure that takes just minutes.
Unlike a bone scan, bone densitometry testing does not involve the
administration of radioactive contrast material into the bloodstream. This
simple test is known as a dual energy x-ray absorptiometry (DEXA) scan, and it can be performed with devices that measure bone density in the hip and spine, or smaller peripheral devices
to measure bone density in the wrist, heel, or finger. The central bone density device is used in hospitals and medical offices, while the
smaller peripheral device is available in some drugstores and in screening sites
in the community. The DEXA scan involves a much smaller radiation exposure than
a standard chest x-ray.
In premenopausal women, estrogenproduced in the body maintains bone density.
Following the onset of menopause, bone loss increases each
year and can result in a total loss of 25-30% of bone density in the first five
to ten years after menopause. Your doctor can help you decide when and if you need a bone density
test. In general, this testing is recommended for women 65 and older along with
younger postmenopausalwomen who have further risk factors for osteoporosis,