How frequently should women get a bone density? A recent study published in the New England Journal of Medicine (New Eng J Med. 366: 225-33. 2012) looked at the length of time it takes to develop osteoporosis and thus how frequently screening for the disease should be considered.

The study showed it takes more than 15 years for 10% of women with a normal bone density to develop osteoporosis (this applies also to women with a mildly low bone density, T-score -1.01 to -1.49). Please go to my website for an explanation of T-score: http://www.womensdoctor.com/site/osteoporosis. If there is a moderately low bone density (T-score -1.5 to -1.99), it takes  4.7 years for 10% of women to develop osteoporosis, and 1.1 years for 10% of women with severely low bone density (T-score -2.0 to -2.49).
Just because Medicare and many private insurances will pay for a DXA (bone density) scan every two years does not mean it should be done that frequently. Both physicians and patients should become more socially responsible and not overuse resources. If a test, procedure, or treatment does not improve outcome, it does not make sense to do it. My recommendation is to perform bone density no more frequently than every 5 years if the initial study is normal or mildly low. Family history, risk factors, and initial bone density should affect the recommended testing frequency.

Risks for fracture include previous fracture, smoking, use of corticosteroids and some other medications, rheumatoid arthritis, low BMI, and cessation of estrogen therapy. Corticosteroids are medications used to treat inflammation such as prednisone; BMI is basal metabolic index which is calculated based on weight compared to height (tall thin women are at higher risk for fracture than short obese women). Caucasian women are at higher risk than non-Caucasian women.

Finally, the gold standard for measuring bone density is called central DXA. Simply put, measurements are taken of the lower spine and hip using Dual-emission X-ray absorptiometry  (a special type of low dose x-ray). Bone density may be taken of the heel, finger, or wrist with equipment (sometimes using ultrasound) that does not give the same meaningful information that central DXA does.

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JUST FOR FUN – One of my favorite musical groups is Celtic Woman. The male counterpart to this group is Celtic Thunder. The attached music is a really upbeat song that has to make us feel happy: http://www.youtube.com/watch?v=-iP27eatYxE&feature=share

We do not have to travel very far to see dramatic landscapes. This sunset was shot a short walk from my home on Isle of Hope.

You may have to click View Images at the bottom of the page to see the photo

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In The Kitchen With Dr. B. – Scallops with Grapefruit

Scallops come in two sizes, small bay scallops and larger sea scallops. This recipe calls for sea scallops. When purchasing seafood of any kind, make sure it does not smell fishy – if it does, it will taste fishy. The other consideration with scallops is to make sure they are dry and chemical-free. Some scallops are treated with sodium tripolyphosphate to make them look white and wet and to absorb water to make them weigh more. But this chemical causes the scallops to be bitter. Check with the manager of the seafood department/store to make sure the ones you purchase are chemical free. I cooked this recipe 2 nights ago with scallops that had the chemical treatment – so bitter I could not finish the dish. Last night I used to non-chemical variety – oh so good! This recipe is relatively quick (under 45 minutes) and serves 2 for entrées and 4 for appetizers.

½ pound sea scallops, patted dry and cut horizontally into ½ inch thick slices
2 tablespoons flour
Salt and pepper to taste
4 tablespoons extra-virgin olive oil
½ cup dry white wine (sauvignon blanc)
4 tablespoons chicken broth
2 tablespoons minced shallot
2/3 cup fresh grapefruit juice
1 teaspoon grated grapefruit zest
1 teaspoon sugar
5 tablespoons cold unsalted butter cut into small pieces
2 tablespoons thinly sliced green onions
Fresh grapefruit sections for garnish (1-2 grapefruit) - see below*

Heat the olive oil (do not let smoke) in a non-stick skillet large enough to hold the scallops in one layer not over-lapping. Toss the scallops with flour and salt and pepper in a bowl or plastic bag (just before you cook), shake off the excess flour, and sauté in the hot olive oil until lightly golden on both sides (maximum of 2 ½ to 3 minutes). They should be just firm. Transfer the scallops to a plate, and pour off excess oil from the skillet. Add the wine to the skillet and deglaze the pan, scraping up the brown bits. Stir in the chicken broth, shallot, grapefruit juice, zest, and the sugar. By the way, zest of any citrus fruit is the outer layer of the skin removed and chopped finely. You can purchase a utensil called a zester or even peel the very outer layer with a sharp knife and then chop it finely. Boil this mixture until the liquid is reduced to about ½ cup and strain into a saucepan. Keep the butter cold until ready to use.  Put the saucepan over low heat and incorporate the butter pieces by whisking continuously.  Occasionally remove the pan from heat so the butter is not allowed to separate (**see below). The result will be a sauce that is the consistency of a thin hollandaise. Add the scallops, green onion, and any accumulated juices and allow to just heat through.  Calorie and fat conscious chefs may add just a little butter for flavoring instead of the full 5 tablespoons but this will not be a classic beurre blanc sauce. Divide the scallops between plates and garnish with grapefruit sections. This was delicious last night served with Jasmine rice and fresh carrots. Enjoy!

*The grapefruit should be peeled and the white membrane removed with a sharp knife. Cut out the grapefruit sections between the separating membrane.
**If butter is heated to a temperature high enough, it will completely melt and separate into milk solids and water (the almost white stuff) and butterfat (the yellow oil). If the temperature is just kept warm, this separation will not occur.