Here’s a fun fact: By 2040 there will be an estimated 80,000,000 postmenopausal women in the United States alone.
Here’s another fun fact: There was one, particularly non-postmenopausal woman at Costco on Friday. Which was when I saw this:
And which was when I got all bent out of shape. Which was weird because I like Costco. And I like Fridays. I also like bone density and pharmacists. What I didn’t like was this:
Why? Allow me to explain. There are two ways to estimate* bone density with accuracy. The first is a central dual energy X-ray densitometer, or DXA. People say it dexa, which reminds me of a barely English speaking biomechanics professor I once had who spoke all acronyms like they were words.
Getting a baseline DXA is a fine idea. But, the machine is huge, expensive, requires special training to administer the test, and a special building. And, the test is expensive. Not for you, perhaps, but for your insurance. Which is why the peripheral machine was created. The peripheral machine, smaller with less-difficult-to-use technology, is often used for in-office screenings or at places like (gulp) Costco. You get a quick measure the bone density at the endpoints of your skeleton, like your fingers.
This all seems great, right? Instead of schlepping all the way to an imaging center, where you get a costly, big-picture whole-body scan of the weight-bearing axis of the body, you can now get your finger scanned (for free!) and a chocolate muffin the size of your head.
And, if you have low bone mineral density as determined by the accurate (and, it is pretty accurate) reading of the machine, Hooray!, there is a pharmacist you can talk to right then to get you on the right supplements or medications so you can prevent any further loss. Hallelujah!
But, here’s the deal. Bone density is not homogeneous. Meaning, if you have an issue with your fingers, it does not imply that you have issues elsewhere. Or, if your hands come back as measuring fine, that does not mean that you don’t have bone loss elsewhere, e.g. in the bones of the hip. More simply said, the cheaper, easier option doesn’t tell you JACK about the situation in your bones. Nor are these machines scientifically adequate to track your bone health over a period of time. Every machine is different. Every technician is different. Every interpretation of the data is different. Which means that you will have no idea about the state of your bones from year to year when you indulge in this test.
Clinically, it has been deemed that information gained from the peripheral equipment is not scientifically valid for determining any sort of bone diagnosis. Guidelines have been set. Before referring anyone to any medication, patients should have a central DXA to determine any actual need.
What is happening is many professionals are jumping right to the prescription, using data collected via the peripheral reading and giving a, “well, you might as well start the medication now, there’s no need to have a full test -- they're expensive or unnecessary” or a, “think of the medication as prevention” line. It's noble, trying to save patients money, but if the central test is required for validity and professionals are bypassing it, then WHY EVEN TEST AT ALL? Why not just train checkers at the grocery store to evaluate anthropometric dimensions and spinal curve with their eyes? Then they could just throw in a preventive medication with your bag of bananas.
"You look pretty petite, there, with those little bones of yours. I just measured you with my bar code scanner and you're falling in the risk group at 5'2". Here's some medication. Oh, and a sample of the Calcium Chews. They're on sale this week, $17.00 for a bottle of 450."
WHOOP, WHOOP, WHOOP. The Science Patrol Alarm has just sounded. Please come out with your hands up. This is not how things should be done. This practice is not based in science.
You can see why I was all pushed out of shape. We are moving toward a situation where everyone thinks they are getting science and evidence-based information, when, in fact, the bar has been lowered to meet what people will do -- not what is valid. We’ve seen this standard-lowering before in, um, most aspects of everything. Like puntuation; and spelling. And it’s tragic.
I just can’t handle it happening in Costco.
Et tu Costco?
Now, next to the Hot Pockets® (cue Jim Gaffigan) samples, millions of people will be given misinformation in the name of science. Has our culture become so dependent on convenience that we're down with this? Is our collective understanding of science so low, that we can't evaluate the difference?
“From a strictly scientific standpoint, postmenopausal women should have both a spine and hip bone mass measurement.” - P.D. Miller
Um, hello? Who doesn't prefer their medicine be administered from a strictly scientific standpoint? I thought it wasn't allowed any other way. That is the general assumption anyhow, or am I wrong?
P.S. If you can find the movie quote and tell me where it’s from, you can be my new BFF.
P.P.S. I actually don't think we're getting our health advice from any sort of strictly scientific standpoint, just in case you were wondering if I was delusional. I was being ironic. I do that sometimes. I've also heard of this thing called sarcasm. Thinking of trying it out too.
*Estimation. Bone density tests are not measuring your bone density. Tests only estimate density, based on the image the machine shows them. Why then, pray-tell, does an image not measure bone density? Well, Grasshoppa, as you remember from science class, density is a three dimensional measure. It is how much of something you have in a container. The only way to actually measure your bone density is to cut off your bone, clean off the meat, weight it, and see how high it floats in water and compared to other items with known mass.
Other interesting stuff:
A central DXA has a 6-8% error when compared to real bone measures.
Peripheral data has about a 4% error of the site that it measured as compared to the dry measure of similar bones.
Density Diagnostic Classifications. P.D. Miller. Calcified Tissue International, Volume 66, Number 5, 317-319.