An Ounce of Prevention: Part I

Dr. Babak Larian, ENT and parathyroid surgeon, believes we should all be getting DEXA scans by age 50. CDC standard of care is 65. What's going on?

The current CDC recommendations for osteoporosis screening for women is 65 years of age. But speak to any doctor on the front lines of osteoporosis prevention or treatment, and they will tell you this is insane. 65 is too late. In fact, 40 might be a good time to get a good baseline reading, particularly if osteoporosis runs in your family. And by 50, when we’re in menopause or nearly so, all women should be screened.

If you’ve been following along here, you’ll know I was diagnosed with what I thought was a rare disorder, hyperparathyroidism, following a diagnosis of a much less rare disorder, osteoporosis. After I wrote about this, many of you not only called your doctors to insist you get DEXA¹ scans, several of you—including one of my own family members and a good friend—have now contacted me to let me know that you, like me, discovered via your DEXA that you have full-blown osteoporosis.

Dr. Babak Larian, board certified Ear, Nose, & Throat Specialist, Head & Neck surgeon, and the current Clinical Chief of the Division of Otolaryngology at Cedars-Sinai Hospital in Los Angeles, was not surprised when I told him this news over zoom. Hyperparathyroidism in women, he says, is not as rare as most doctors have been led to believe. That is, if they believe anything at all about the disease, as hyperparathyroidism barely garners a half hour lecture in med school, and the data we collect here in the U.S.—or rather, do not collect, as our healthcare system won’t allow it—is woefully incorrect.

In fact, in a recent retroactive survey in Canada, a full 5% of the population studied had some form of hyperparathyroidism. Not the negligible 0.125% we claim here in the U.S. The study included men and women, and though the data was not disaggregated between the two sexes, if we know that three times as many women as men get this disorder, and that they tend to get it during the homeostatic destabilization period of menopause, we’re talking about a significant number of menopausal women who would be well-served by getting their bones scanned significantly before age 65, if only to find out whether or not they have the kind of adenomas on their parathyroids requiring removal and to avoid the leaching of calcium from their bones from the presence of these tiny tumors before it’s too late to reverse it. I wish I’d had a DEXA scan at 50 instead of finding out at 57 that I have the bones of an octogenarian and a disease I didn’t even know how to pronounce let alone its existence and prevalence in menopausal women.

I’m just hoping it’s not too late to get some bone mass back after my surgery, which will be, well, I’m not sure when. I’m still doing my due diligence to find a decent parathyroid surgeon in my less-than-optimal ACA healthcare plan.

I have recorded my conversation with Dr. Larian below as well as condensing it into a readable Q&A underneath the video. After you watch, I would recommend the following:

1. If you are a woman 50+ years of age, ask your doctor order a DEXA scan. If they say no, the CDC doesn’t recommend screening before 65, come armed with a printout of this article, this study, and this other article and say, “Thanks, but I’m over 50, and I insist.”

2. Ask your doctor to test both your PTH and your calcium and vitamin D level, but know this: normal calcium levels do not necessarily mean you do not have hyperparathyroidism. Make sure you ask for both tests. My D was low and my PTH was high—both indicative of hyperparathyroidism—but my calcium was totally normal.

3. If your PTH is high but your calcium is normal, please go see an endocrinologist anyway. They will do a 24-hour urine test to see if there’s calcium in the urine.

4. Talk to your doctor about going on menopause hormone therapy, including systemic estrogen as a preventative measure against osteoporosis and vaginal estrogen as preventative of the genitourinary syndrome of menopause (GSM).

5. Start lifting weights 3x a week today. Just 15 minutes on those days can do wonders for your bones.

Anyway, here’s our interview. Dr. Larian also has a youtube channel where he explains everything about this disorder and why menopausal women need to be self-advocating for preventive bone care.

The transcript of this interview has been condensed for clarity.

Deborah Copaken: I was only recently diagnosed with hyperparathyroidism. I'm a journalist, and I've been digging into this. The more I dig, the more I think, what the hell is going on here? I have -3.2 bones. I'm 58 years old. I am in excellent health. I exercise, I do everything I'm supposed to do, and I get this diagnosis only because I happen to ask for DEXA scan after I interviewed [Joanna Strober] about osteoporosis.

Dr. Babak Larian: You pushed. You pushed. You pushed, and you pushed, and you pushed.

Talk to me.

Right. Well, there's so many things wrong here.