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Most women should wait until age 65 to get a bone density test that gauges their risk of osteoporosis.
updated 11/23/2008 1:10:52 PM ET 2008-11-23T18:10:52

There are just two problems with the way women older than 50 deal with thinning bones. The first is that many get treatment they don't need, raising the risk of unpleasant or dangerous side effects from potent drugs. The second? Women who do need help often miss out entirely — and dramatically increase their odds of a catastrophic hip fracture.

It's the worst of both worlds, but it doesn't have to be that way. Until recently, doctors weren't able to reliably identify women whose bones are in enough danger to warrant medication. But thanks to a new risk-assessment test and updated treatment guidelines, that's changed — and now, outdated ideas are the only obstacle between you and a skeleton that's healthy for life.

Here, four bone myths — and the truths that can keep you standing tall.

Myth: I need a bone density test at menopause
Most women should wait until age 65 to get a bone test that gauges their risk of osteoporosis, a disease in which bones become so porous they can break with little provocation. The 10- to 30-minute procedure uses an X-ray machine, known as DXA, that exposes you to a very low level of radiation.

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Video: Picture of health: Osteoporosis Getting tested too soon might lead to unnecessary drugs, says Nelson Watts, MD, director of the University of Cincinnati Bone Health and Osteoporosis Center. That's worrisome not just because of potential side effects but because research suggests the drugs become less effective over time.

However, you should ask your doctor about getting tested earlier if you have a family history of the disease, have broken a bone as an adult, are Caucasian or Asian, have a small frame, take certain medications, or have a condition that increases risk, such as inflammatory bowel disease or multiple sclerosis.

Myth: I'm past 65 but don't have to worry — my doctor hasn't suggested a bone density test
Shockingly, only a fraction of women 65 and older are offered the test by their physician, says Watts, even though this age group is at heightened risk of osteoporosis. "Medicare reimbursements for the DXA test have declined by 40 percent since 2006. The procedure now costs doctors more than they are paid, so they don't push it," he says. Legislation to boost reimbursement has been introduced, but so far it hasn't passed. If you're 65 or older, demand the procedure. How often you should be tested after that depends on the results and other health circumstances.

Myth: If I have "pre-osteoporosis," I should start taking drugs
For years, doctors didn't know what to do with patients diagnosed with osteopenia, a condition in which bone mineral density is lower than normal but not yet in osteoporosis territory. "Some doctors started these women on drugs; others didn't," says Watts. "There were no clear guidelines."

Why that matters: Commonly prescribed drugs called bisphosphonates can cause side effects, including flulike symptoms and difficulty swallowing. In very rare cases, patients have developed severe joint or muscle aches months or years after starting treatment.

But this year, the World Health Organization unveiled a risk assessment calculator, called FRAX, that goes beyond bone density to consider 11 other crucial factors in bone health, such as family history or taking skeleton-sapping medications. "It gives a much better sense of a woman's true risk of getting a fracture, and it provides guidance about who needs treatment — and when," says Watts. The National Osteoporosis Foundation recommends medication for postmenopausal women if they have osteopenia and their FRAX shows a 10-year fracture risk above 20 percent. Ask your doctor to calculate your FRAX score, or go online and crunch the numbers yourself at (click on "Calculation Tool," then "US" and your ethnicity).

Myth: I'm too old to build bone
You've probably heard that your skeleton was built mostly in adolescence and young adulthood, and that the lack of estrogen after menopause greatly accelerates bones' decline. But making healthy lifestyle choices when you're older can still have a positive impact on your skeleton, says Felicia Cosman, MD, clinical director of NOF. "Even small gains add up over time," she adds. According to research from Tufts University, postmenopausal women who did strength-training twice a week for a year gained 1 percent to 2 percent in bone density. Any weight-bearing workout can provide similar benefits. The key: Keep increasing the intensity.

Although food can't build bone density, the right diet can drastically slow your rate of loss. Be sure to include calcium-rich choices in yours; to see if you're hitting 1,200 mg of calcium a day, go to to calculate the amount you're getting from food. If you're falling short, take a supplement — divide it into two doses if you're popping more than 500 mg. And aim for 1,000 IU of vitamin D daily through food, sunshine, and supplements; it works with calcium to maintain bone mass.

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