Chapter 1

I first considered having a bone density test when I turned forty a few years ago, but not because I was overly concerned about osteoporosis, ironically. I had decided I was done with childbearing after having three perfectly healthy, wonderful children. I had always thought that I should strongly consider having my ovaries removed preventively, since my mother succumbed to an incredibly virulent form of ovarian cancer in the prime of her life. In addition to my family history, one of the important components of this decision was determining my risk of osteoporosis. As an osteoporosis specialist, I had ready access to bone density testing-the only way to accurately determine osteoporosis risk-but I had never had the test done because I was always either pregnant, nursing, or anticipating becoming pregnant.

Even though I'd been meaning to get the bone density test, what directly precipitated my going in was that a good friend of a similar age was having a screening colonoscopy (her father had died from colon cancer). We had also both had our first mammograms about a year or two earlier. This seemed like a good time to round out the medical picture.

I didn't anticipate anything dramatic in my bone density measurement results. My guess was that I would be close to average. I was always of average size, had regular menstrual periods, no significant smoking history, no excessive alcohol intake, good basic nutrition, and fairly regular exercise. I have always been strong and healthy. Nothing to worry about.

How wrong I was! It turned out that my spine bone mass was in the lower 1 percent for my age. That meant I had full-blown osteoporosis, with a spinal bone mass T-Score of -2.7. Comparing my age-matched results (Z-Score) to those of a majority of my patients, my bone mass was worse than almost all of them. Of course, I repeated the test a few times; it just couldn't be right, but all the results came out very similarly. I was numb with the fear that my back would crumble, I would become deformed and disabled, lose six inches of height, and suffer from chronic back pain, when just ten minutes earlier I'd been a healthy young woman with an absolutely fantastic life.

I shared my bad news with everyone-especially my friends and colleagues at work. We joke now about how I mentioned my bone mass every single day at our daily lunch for at least a year. Every time I came down from the outpatient department at my hospital after seeing patients, I mentioned that my bone mass was far worse than anyone I had seen that day. I had some blood and urine tests done to try to exclude any possible underlying diseases that might cause such a low bone mass. These tests didn't reveal much of anything.

In the days when I first began working in the osteoporosis field, I would have definitely recommended a bone biopsy in a person such as myself. Bone biopsies were occasionally done in patients with particularly low bone mass for their age to help exclude other diseases and to try to gauge the underlying bone turnover rate. Doctors are not doing many of these anymore, except for research purposes. Blood and urine tests have largely taken over for both of these purposes.

I remembered that my mother had had some compression fractures of the spine, seen on X ray, when she was having tests done for the abdominal discomfort that ended up being ovarian cancer. At the time, it was just an incidental finding, of little importance compared to her primary disease. My brother said she often had backaches, though she never complained of any serious back pain and never sought medical advice. She stoically worked through any pains or illnesses. She did have a bit of a stooped posture and had lost some height from her peak at five feet, eight inches. This was 1987, a time when there was little discussion about osteoporosis and bone density tests were not yet standard medical practice. Little was known about prevention or treatment, so I put this out of my mind. However, there is no doubt that having a family history such as mine puts you at higher risk for having the disease yourself. In fact, it may be one of the most important factors.

Copyright © 2003 by Felicia Cosman, M.D.

Tags: Osteoporosis, Women's Health

About the Author

FELICIA COSMAN, M.D., an osteoporosis specialist, is the clinical director of the National Osteoporosis Foundation, the medical director of the Clinical Research Center at Helen Hayes Hospital in West Haverstraw, N.Y., and associate professor of clinical medicine at Columbia University.