Denton Cruse had no idea what he was in for when he attempted to wrestle a 250-pound television set out of an entertainment center last April. "I felt something pop," the Atlanta marketing consultant recalls. "There was incredible pain. It was extremely difficult sleeping, getting out of bed, getting out of a chair or sitting down."

What Cruse experienced was a compression fracture in his vertebra, a condition that might have been prevented had Cruse and his medical providers known that he was at risk for such a break. At 63, Cruse is relatively young to experience such a fracture, but the issue should be on the radar screen for anyone reaching the half-century mark — especially women who begin to lose bone mass more rapidly after menopause.

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Milk is good for your bones.

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"Something like 10 million Americans have osteoporosis [a significant loss of bone mass], and another 33 to 34 million have low bone mass [or osteopenia] and are also at risk for fractures," stresses Dr. Ethel Siris, president of the National Osteoporosis Foundation, and a professor of clinical medicine at Columbia University in New York. "We know that one in two women and probably one in five men will fracture a bone because of osteoporosis-related issues after age 50."

However, Siris and other bone health experts are hopeful that a new method for assessing fracture risk will give clinicians and their patients the information they need to do a much better job of preventing fractures in the future.

It's not just about bone density

A hallmark of the new approach is that it takes many factors into account to determine a person's risk of fracture. In the past, clinicians mainly relied on results from a bone mineral density test — a measure of bone mass — to determine whether a person should be placed on a bone-strengthening drug. However, in studies over a number of years in multiple countries, investigators associated with the World Health Organization have verified that many other factors are important in determining fracture risk as well. These include:

• Height and weight

• Older age

• Gender (women are more vulnerable to fractures at a younger age than men)

• Previous fractures as an adult

• A parent who suffered a hip fracture

• Smoking

• Excessive alcohol intake (three or more glasses a day)

• Rheumatoid arthritis, an autoimmune disorder involving the joints

• A history of taking a class of drugs called glucocorticoids, such as prednisone or cortisone, for an extended period of time

• Secondary osteoporosis (conditions associated with osteoporosis such as insulin- dependent diabetes, hypothyroidism, chronic malnutrition, etc.)

A simple calculation tells the story

To help clinicians make better treatment decisions for their patients, researchers have developed a simple online tool called Frax that takes all these factors into account, weighs each one and performs a calculation that enables clinicians to determine a person's estimated risk of experiencing a fracture in the next 10 years.

Dr. David Zelman, a rheumatologist who interprets all Kaiser Permanente's bone density scans in Atlanta, believes one of the tool's main advantages is that "it gives you specific numbers that you can relate to people. You can say that according to this calculator, you have a 4 percent risk of having a fracture in the next 10 years," he says. "It allows us to explain this in a way that I don't think we were able to do previously."

Dr. Roberto Pacifici, director of the Division of Endocrinology at Emory University, agrees, noting that in the past, by relying so heavily just on bone mineral density results, physicians have tended to overtreat younger women who are at low risk of a fracture, and to undertreat older women who are at high risk. He believes the new tool will help to correct these mistakes by arming health practitioners and patients with a more detailed picture to make better decisions.

Anytime someone breaks a bone from something other than a massive trauma, their skeletal system needs to be examined more closely to make sure that it is not a symptom of a larger problem, says Dr. Scott Boden, director of the Orthopaedics and Spine Center at Emory.

For example, Cruse fractured his foot five years before breaking a vertebra, but the incident was simply viewed at the time as a freak accident. He is taking the vertebral fracture much more seriously, however, even though surgery and physical therapy have enabled him to fully recover.

"I take a full dose of [calcium and vitamin D] every day, and I do stretching exercises that the physical therapist gave me to strengthen my back muscles," he says. "They help to keep me in the right position so that I am less likely to be doing things the wrong way."

DO YOU NEED A BONE MINERAL DENSITY TEST?

Most women should undergo a bone mineral density test by age 65, although physicians frequently recommend the test at menopause or even earlier if a woman has risk factors that might make her more vulnerable to a fracture, or she has experienced a fracture in recent years. The test is also recommended for men, but not until age 65 or 70.

There are a number of ways to measure BMD, but the most accurate way is through dual-energy X-ray absorpitometry (DEXA). This completely painless test is typically offered at the same types of imaging centers that perform standard X-rays and mammograms. Women can often undergo the test at the same time and location as their regular mammogram. The approach uses two X-ray beams to essentially measure the density of minerals, such as calcium, in the spine and the hip.

The results of a DEXA test are presented as T scores:

• If your T score is between 0 and -1, your BMD is considered normal.

• If your score is between -1 and -2.5, you have osteopenia or low bone mass, although researchers believe your risk of fracture depends on a number of factors, not just BMD. Your physician may recommend treatment and/or lifestyle changes.

• If your score is -2.5 or below, you have osteoporosis. Your physician will probably recommend lifestyle changes to strengthen your bones as well as treatment options, including a number of drug therapies that help to preserve and build bone mass.

Sources: WebMD, National Osteoporosis Foundation

RECOMMENDATIONS TO BUILD

BONE STRENGTH

• Exercise regularly. Weight-bearing exercise, such as walking or running, is most important because it helps to keep bones strong. However, muscle-strengthening exercises are also recommended.

• Make sure your diet is rich in calcium. Dairy products such as milk, yogurt and cheese are good choices, but there are also a number of nondairy products that contain calcium. These include salmon, tofu, baked beans, broccoli, spinach, peas, sesame seeds and almonds. Many foods, such as juice drinks and a number of breakfast cereals, are also fortified with calcium, so read labels carefully.

• The National Osteoporosis Foundation recommends that adults older than 50 also take 1,200 milligrams of calcium and 800-1,000 IU of vitamin D3 daily. D3 is a form of vitamin D that best supports bone health.

• Avoid smoking and excessive amounts of alcohol.

• Talk with your health care provider about bone health, especially if you are older than 50.

• Get a bone mineral density test by the age of 65 if you are a woman and by age 70 if you are a man.

Source: National Osteoporosis Foundation