Testing Beyond Bone Scans

Bone Testing: Bone Scans and Beyond

1. Vitamin D Blood Test:

Dr. Michael F. Holick, Director of the Vitamin D, Skin and Bone Research Laboratory at Boston University Medical Center, is a leading expert on Vitamin D in this country. He and many others recommend a vitamin D test for 25-hydroxyvitamin D (not 1,25-dihydroxyvitamin D). At least half of the vitamin D tests done are for 1,25-dihydroxyvitamin D, and the findings are not useful for most of us. You need to inform your health care practitioners about this to make sure you get the right test.

Holick says that 25-hydroxyvitamin D below 25 nanograms per milliliter is inadequate. From 20-30 is borderline adequate. From 30-50 is healthy. If you are low in vitamin D, you won’t have good absorption of minerals from foods. Adequate Vitamin D also stimulates activity of the osteoblasts that make and lay down the bone matrix (structure for mineralization).

Vitamin D intake: Recent research in the Boston Area supplemented healthy young and middle-aged adults with 1000 IUs of vitamin D a day winter and early spring. This raised blood levels of vitamin D to 30-40 nanograms per millileter, just where they should be. It's now clear that 1000 IUs of vitamin D per day is not toxic and should be used by women with bone density issues or those who want to prevent bone density problems. I take 1000 IUs of vitamin D a day between November and April, but 600 IUs in the summer when I expose my skin to the sun for 10-15 minutes a day (never long enough to burn). With this amount of supplementation, my vitamin D levels are excellent, but some people need more and some less. It's good to be tested and then to be retested in a year or two.

2. Bone Resorption (breakdown) Urine Test

a. NTx Osteomark Test for Telopeptides of Type I Collagen (a protein found in bone breakdown: higher levels of this protein = more bone breakdown

Information for interpreting NTx test on page 217, Susan Brown, Better Bones, Better Bodies

Women with low hip bone density and high bone turnover rates were 4 times more likely to fracture a hip than those with only one of these factors. If you have low bone density, but have low bone breakdown or resorption now, you’ve likely stabilized or are increasing bone density.

b. Deoxypyridinium urine test: measures collagen crosslinks, pyridinium and deoxypyridium (both present in bone and high when bone breakdown is high

3. Acid/Alkaline Balance

from Susan E. Brown, Better Bones, Better Body

Urine pH test:

Buy a packet of pH hydrion test paper (or litmus paper) at a drug store. Brown suggests testing paper with half point divisions (6. 6.5, 7, 7.5, etc.), but full point divisions (5, 6, 7) will work if that's all you can find.

Wet the test tape with first morning urine.

Match color of tape on test strip to get pH.

Write down the result: below 7 = acid. The lower the number, the more acid. Ideally the first morning urine pH should be between 6.5 - 7. An occasional 7.5 to 8 reading is OK, according to Brown. If reading is below 6.5, make your diet more alkaline with more fruits and vegetables and other alkalinizing foods. She has extensive charts about which foods are alkalinizing and which acidifying. I can’t vouch for all of the details, but it is clear in research that this pH issue is important and that a diet high in fruits and vegetables keeps the body in an alkaline state and promotes bone health.

Foods to make your body more alkaline (get a complete list in Susan Brown’s book or website www.betterbones.com:

Fruits and vegetables
Juice of ½ lime, lemon, or T cider vinegar in water (alkalinizing minerals in these foods)
Yams and sweet potatoes
Dark leafy greens, seaweed, oats, quinoa, wild rice, fruits in season
Vitamin C

Acidifying foods: the typical American diet of processed carbohydrates, lots of meat, and sugar.

4. Other Possibilities To Discuss With Your Doctor

a. Parathyroid Hormone Level:

High parathyroid = removes excess calcium from bone in response to low calcium blood levels, so overactive parathyroid gland causes bone loss
High PTH associated with calcium and D deficiency. At Mayo Clinic, young women with 500 mg calcium and 1,500 mg phosphorus had excess PTH, so in this study excess phosphorus in relation to calcium promotes bone loss

b. Thyroid Hormone Levels:

Thyroxin Level:

High levels from overactive thyroid gland (hyperthyroid) or excessive medication = increased bone breakdown with overactive thyroid or excessive medication.
Low levels from underactive thyroid gland (hypothyroid) = decrease in calcium absorption

Calcitonin: a thyroid hormone that works in balance with parathyroid hormone and adds calcium to bone by lowering urinary loss.

5. Dexascan testing: What Is A Significant Change?

Small changes in your dexascan, whether the density goes up or down, aren’t terribly significant. According to the experts, you need a 5% change in hip density or a 3% in spine to assure significance, but I had tests 2 weeks apart and the spine was almost 6% different on the same machine with the same operator. Look for a long-term trend over a number of years and remember that by following a bone building exercise and nutrition plan, you are lowering fracture risk dramatically even when the dexa scan doesn’t show improvement. See My Experience With Dexa Scan Accuracy.