Welcome to the second in the Bodyscan series of three videos taking a closer look at the favoured DEXA scan metrics of Dr Peter Attia, author of bestselling book Outlive.
Our first video was about visceral fat. In this second video, we take a deep-dive into bone mineral density, or BMD.
The strength of your bones is proportional to their density. The higher the density (to a point), the more solid and strong the bones and the less likely they are to fracture, whether that’s from playing rugby, in a car accident or simply from falling over.
Quoting US data, Attia says that falling over and related fractures are by far the leading cause of accidental deaths in those aged 65 and over.
He then states a startling statistic: “the mortality from a hip or femur fracture is staggering … up to one-third of people over sixty-five who fracture their hip are dead within a year.”
That’s why he tests his patients’ bone density every 12 months with a DEXA bone scan.
These are the bone density graphs for males and females from early childhood to age 20, clearly showing that BMD rises rapidly in early years.
Beyond age 20, we can see that bone density continues to rise more slowly and then falls, with men reaching peak BMD at around 30, and women at around 40.
You can also see that the range for BMD values, from the bottom of the dark blue to the top of the light blue, is higher for men than women, and declines much more rapidly for women, usually after menopause.
When it comes to measuring bone density, it’s important here to draw a distinction and explain the difference between bone scans and body scans. In my view, Attia does not do that as clearly as he might in Outlive.
DEXA bone scans and DEXA body scans are two different modalities. Although a body composition scan provides only an indication of bone density (that is, a doctor would not make a definitive medical diagnosis), it IS based on the scanning of all your bones, and if your result is low we will strongly advise you to seek specialist medical advice.
Although the two scan modalities are different, the advantage of a body scan is that it provides an indication of bone density, whereas a bone scan gives no information at all about body composition.
The definition of ‘normal’ bone density is that your result is in common with 95% of the local population of the same age, sex and ethnicity, which means we expect to see only 5% of people outside this range, 2.5% at the low end, 2.5% at the high end.
Bone fractures are more likely if bone density is low, with conditions such as osteoporosis and osteopenia.
If we return to our DEXA bone density graphs, the blue zones represent the 95% of the population classed as normal. In mathematical terms, the normal range is defined by what are called Z-scores, from -2 at the bottom to +2 at the top. The middle line, the average, is a Z-score of zero.
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