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Do women need regular bone density exams?

Unfortunately, there's no one-size-fits-all answer. The National Osteoporosis Foundation recommends that all women 65 and older get a baseline bone density test. Bone loss is typically so slow that repeating the test more often than every two years is not necessary. Medicare and most insurers will pay for testing every two years.

Assessing a woman's risk for more rapid bone loss is too complex for blanket recommendations, Dr. Robert Neer, director of the Osteoporosis Center at Massachusetts General Hospital, said in an e-mail. And some women - as well as some men - need a bone density X-ray test to look for signs of bone thinning even before age 65 if they have certain medical problems.

Some people need earlier or frequent testing, including women with early menopause (before age 42) and men with androgen deficiency, because both of these conditions can lead to bone thinning. Anyone who gets a fracture after minimal trauma and people with rheumatoid arthritis should also ask their doctors about earlier or more frequent testing. So should people who take cortisone or prednisone, which can adversely affect the bone, and people with sprue, cystic fibrosis, or inflammatory bowel disease.

The trouble is that it can be tough to get insurance coverage for earlier or more frequent testing. In theory, Medicare will pay for more frequent testing when it's "medically necessary." But in nearly all cases, Medicare does "not accept a letter from a physician as proof of medical necessity," making it difficult to assess whether a newly prescribed medication has stopped bone loss, Neer said. Medicare has also reduced its payments for the bone X-rays and plans to do so again next year, discouraging many small providers from performing the tests, Neer said. Even so, it makes sense to ask your doctor about testing before age 65 if you think you are at particular risk for osteoporosis.

JUDY FOREMAN

E-mail health questions to foreman@globe.com.

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