I recently asked my doctor for an osteoporosis test and he told me the nearest X-ray machine for this was 50 miles away. If this test is so important for women approaching menopause, then why doesn't our local hospital offer it?

--Loreene

The test you're probably referring to is called absorptiometry -- a method of measuring bone density using a machine called a dual energy X-ray absorptiometer, or DEXA. Although a DEXA measurement of bone density in the hip and spine is considered the current "gold standard" for osteoporosis screening, this test isn't routinely offered at all health care facilities.

If your hospital doesn't offer absorptiometry, it may be because of the cost of the DEXA itself. The machines are quite expensive and not all hospitals have the funds for them. Some smaller health care facilities may not have the space for DEXA machines -- the ones that measure bone density in the hip and spine are rather bulky.

Bone density testing is an important screening tool for osteoporosis, but it's also important to remember that not all women need this type of testing. DEXA is only recommended for women at high risk for osteoporosis and for women who are not sure about taking estrogen in menopause. In the latter group, if osteopenia (bone thinning) is already present, this may be a good reason for the woman to take estrogen. Risk factors for osteoporosis include a family history of osteoporosis, a small frame and thin build, smoking, being postmenopausal, a history of long-term steroid or heparin use and white or Asian ancestry. Certainly if you have a couple of these risk factors and if you are on the fence about taking hormone replacement, then you should have bone density testing.