When it comes to bones the old adage ?bigger is better? is accurate. Women are four times more likely than men to develop osteoporosis ? a condition where bones become brittle, weak and susceptible to break. Small boned women face even higher odds of developing the disease.

Terri Farnan, who operates the bone densitometry unit at King Edward VII Memorial Hospital (KEMH), said that ethnicity is also a large factor.

?Darker skins have stronger bones,? she said. Research ties the pigment melanin, which is responsible for the shade of your skin, to bone mass. A high concentration of melanin usually equates with strong dense bone.

Ms Farnan said Black people typically have bigger bones than Caucasians with Asians tending to have the smallest bones. She said osteoporosis is highest among Asian women and less prevalent in Black women.

But no one is safe from developing the disease. Alcoholics, men with low testosterone levels and those on steroids are also at high risk. A diet rich in nutrients that support bone production and proper exercise is necessary.

The female hormone oestrogen is also tied to the disease.

As women enter menopause they naturally produce less oestrogen and their bones begin to deteriorate. This is the population most at risk in Bermuda.

Osteoporosis is a gradual disease that can be treated when caught early. Much like dentistry, most treatment relies on screening and preventing the disease from taking root.

People who develop osteoporosis typically break or fracture bones in their spine, hip or wrist. While these are the most common areas, bone anywhere in the body can be affected.

And breaking bones can be costly and debilitating. Hip fractures almost always require surgery and hospitalisation. It can impair a person?s ability to walk unassisted and may cause prolonged or permanent disability and even death.

Fractures of the vertebra (bones of the back) can cause severe back pain, loss of height and deformity. Wrist fractures are also painful and can impede or completely prevent sufferers from performing regular daily manoeuvres.

Screening can be done in a variety of methods. In Bermuda both KEMH and TB Cancer & Health have a bone densitometry unit. In bone densitometry, low dose X-ray machines actually read the mineral content of bone.

The procedure is non-invasive and painless- much like getting a traditional x-ray.

Radiologists carrying out the procedure usually make two separate scans: one of the lower back and one of the hip areas.

Bone in these areas is different growing at different rates.

According to Ms Farnan, calcium is more easily lost in the type of bone found in the spine (bone in the back). Women approaching menopause may find a low bone density reading for this area and a normal one for their hip, where the bone is more stable.

At KEMH the machine used cannot support a weight of 300 pounds or over. In cases where the patient is too heavy, a reading is taken from their forearm.

Metal will cause the scanner to give a false reading, and so people with metal pins or plates in their back or hip also have their forearm scanned.

At KEMH Ms Farnan said about 20-25 people are tested each week. ?We don?t have a lot of men. We might see about one a week. Usually they have low testosterone levels are they are on medication like cortico-steriods,? she said.

Patients must be referred by their doctor to have the scan in the first instance but Ms Farnan said the Bone Densitometry Department then follows up with patients who may need to return.

?This is not like mammography where patients come every year,? she said. ? This is very specific to the individual and the follow-up scan may be needed in two years time or three years time. It depends on the stage of bone loss.?

The scanner used at KEMH issues two results a T score and a Z score. The T score compares the bone density of the patient with that of an ideal healthy bone and the Z score with healthy bone of people in the age group of the patient.

The comparisons are based on classifications set by the World Health Organisation.

Results can fall within three bands ? normal with T scores of -1 to 0, osteopenia ? the first stage of bone loss with T scores between -1 and -2.5 and osteoporosis with T scores of -2.5 and higher.

Where osteopenia is detected patients are advised to do more weight bearing exercise and increase their calcium intake to the recommended daily dosage. This can be done by eating more foods high in calcium or by taking a calcium supplement.

In the case of osteoporosis patients may have to take prescription medication.