The Bone Density Service is part of the “Falls Clinic”. The referrals are triaged (under 65 years of age by the endocrinologist, over 65 years and older by the geriatrician) to either be seen by the geriatrician and have a bone density scan, or have a bone density scan alone which is then reported by the clinician to the requesting doctor. The patients triaged to see the geriatricians are usually older people with falls and fractures. What is bone density? Bone mineral density is a measure of the amount of mineralised bone per unit volume of skeletal mass, usually expressed as gram/cm2. It is one way of measuring the strength of bones. How is bone density measured? Methods available in Auckland include: ultrasound estimates (usually on the heel), CT measures of the lumbar spine, or dual energy X-ray (DEXA) measurements on the lumbar spine or hip. Plain skeletal radiology is too insensitive for clinical use and may be misleading unless obvious osteoporotic fractures are present. DEXA scanning is used by the Middlemore Bone Density Clinic. For more information on what to expect during your scan and about DEXA please click here. Who should have bone density measurements performed? Those with symptoms related to possible osteoporosis e.g. any fracture with minor trauma, vertebral pain/crush fracture and kyphosis. Those with a strong family history of osteoporosis. Those with known risk factors for osteoporosis e.g. steroid use, catabolic illness, early menopause, thyrotoxicosis, hypogonadism, hypopituitarism, insulin dependent diabetes, low calcium intake etc. Consideration can be given to screen those with possible risk of osteoporosis e.g. smokers, slim build, inactivity, postmenopausal women. Referral expectations Patients already in the hospital (inpatients) can be referred by specialists within the hospital. Patients in the community (outpatients) will be referred by their GPs on a designated referral form or a letter with clinical details of the patient and the reason for requesting bone density. There are no charges for NZ Residents. Osteoporosis Questionnaire (PDF, 52.4 KB) Osteoporosis Guidance (PDF, 1.1 MB)

DEXA (which stands for dual energy x-ray absorptiometry) scanning uses special x-rays to measure the density of your bones. The density of your bones will show how strong they are. The exposure to x-rays is very low and is similar to what you would receive on a long distance plane flight. When you are coming into the hospital to have a bone density scan please observe the following: The bone density scan uses extremely small amounts of x-ray (one twentieth of a chest x-ray). A bone density scan should be avoided in pregnancy. You will lie very still on a padded table for 5-10 minutes while the arm of the machine passes over the area to be measured (usually the lower spine and hip, although the forearm can also be measured). This is quite painless. You do not have to undress but metal objects (buckles, zips, girdles, underwire bra, jewellery etc) interfere with the scan and may need to be removed. A copy of the scan will go to your referring GP with a written interpretation by one of the specialists. For more information and images about DEXA scanning click here.

Bone is living tissue which is constantly undergoing remodelling with new bone being formed and old bone being broken down. The tough outer core of bone surrounds an inner 'spongy' area of interlacing bone. This arrangement of bone gives it great strength. Bones are always being remodelled and rebuilt to keep them strong. In osteoporosis, the harder outer shell of bone slowly thins out, whereas the inner network of bone undergoes more rapid breakdown. Although the size of the bone stays the same it becomes a lot thinner and weaker on the inside, in medical terms you lose 'bone mass'. Losing calcium from your bones is a natural part of the aging process. As you grow older, particularly after menopause, the body takes calcium from your bones more quickly than you can replace it. Osteoporosis is not painful but it makes your bones more prone to breaking (fracture). Women are more likely than men to suffer from osteoporosis and as you get older you are more likely to have it. http://osteoporosis.org.nz/resources/brochure-all-about-osteoporosis/ Tests Osteoporosis can be diagnosed by measuring bone mineral density (BMD). At the Middlemore Bone Density Clinic, the bone densitometry examination is a DEXA scan. DEXA is the state-of-the-art method for detecting osteoporosis. Research has shown it to be more reliable than other methods i.e. CT or ultrasound. The examination is painless and delivers only a small dose of x-rays. We routinely check the bone density of the spine and hip; sometimes the wrist is used to measure bone density. A copy of the results will go to your referring doctor with a written interpretation by one of the specialists. For more about the DEXA examination click here. Treatment Exercise - such as running, walking, tennis, aerobics and dancing. These are called weight bearing exercises and are best for your bone health. Sunshine - vitamin D is important for absorption of calcium. You normally get enough vitamin D from the action of sunlight on your skin, even on an overcast day. Foods which contain vitamin D include fish oils, sardines, tuna, eggs, butter and liver. Diet - you need a good intake of calcium throughout life. This is an easy and natural way to help slow bone loss by providing your body with the calcium it needs. Dairy products including cheese, yoghurt, ice cream and milk provide the great majority of the calcium in the diet. Calcium Supplements - if you don't like or can't eat enough calcium rich foods, then taking a regular calcium supplement may be best for you. They need to be prescribed by your doctor. Vitamin D (Calciferol) - is prescribed particularly for those with vitamin D deficiency. Hormone Replacement Therapy (HRT) - is made from hormones similar to those produced in the body before the menopause. Oestrogen or oestrogen and progesterone can be used. Other Treatments - there are other methods of treating osteoporosis for those people not suited to HRT. These include Bisphosphonates e.g. Etidronate (Didronel), Alendronate (Fosamax) or Calcitonin, Rocaltrol and anabolic steroids. Zoledronate (as an infusion) is another treatment method for patients intolerant of oral bisphosphonates, and although CMDHB no longer provides this service to outpatients, your GP will be able to discuss this treatment option with you. Please refer to the attached information sheet regarding Zoledronate administration for outpatients in the community. Zoledronate Infusion Centres (PDF, 34.2 KB) Osteoporosis Questionnaire (PDF, 52.4 KB) Love your Hips (PDF, 3.3 MB)

These are not a natural part of aging. There are many reasons why people fall over and a review of your medical problems and medications may well reveal some reasons for falling that can be fixed. If you have lots of falls, seeing a specialist as well as the physiotherapist and occupational therapist can reduce your chances of falling again. You will be asked about the circumstances surrounding your falls and it is helpful if family or friends who witnessed your falls come into the clinic with you. You will have an examination looking at your general health as well as strength, balance, vision and memory. An occupational therapist may come to your home to look into any changes that can be made to improve safety. Paste this address into your browser to the Live Stronger for Longer website for information to prevent falls and fractures www.livestronger.org.nz Love your Hips (PDF, 3.3 MB)