This edition is coming about due to my recent
experience in space-age diagnostic medicine at
The Cooper Clinic(R), an element of the Cooper Aerobics Center in Dallas, Texas. Imagine
having your upper body quickly scanned by a moving X-ray ring and sitting down to review the
images from that scan on a large computer monitor about five minutes later. You didn`t even take your
shirt off for the procedure and the worst part was you had to hold your breath for about 20-30 seconds
three times. The images you view will tell you your risk of heart attack due to calcified atherosclerotic
plaques in the coronary vessels, find many tumors or anatomical abnormalities in your chest or abdominal
wall region and any organs contained there, and you`ll know your bone mineral density. That, and the
results of thousands of these scans that show a high percentage of "normal" "healthy" men have either
osteopenia or osteoporosis, is the reason for a special Men`s Osteoporosis Support Group Newsletter.
The Cooper Aerobics Center
Dr. Kenneth H. Cooper`s first book, Aerobics, popularized not only the term but the entire form
of exercise. Before this book was written, about the only joggers or runners were on high
school, college, or Olympic teams. Now, as we all know, joggers, and people doing all forms
of aerobic exercise, are everywhere. Dr. Cooper founded The Cooper Aerobics Center in Dallas in 1970
as a way to carry on the knowledge he had gained while developing the Aerobics Point System while
serving 13 years in the U.S. Air Force as a flight surgeon. The philosophy of the center is that it is easier
to maintain good health through proper exercise, diet, and emotional balance than it is to regain it once it
is lost. There are five major elements within The Cooper Aerobics Center that I will summarize from
brochures available from The Cooper Aerobics Center.
The Cooper Clinic(R) provides the most up-to-date preventive medicine expertise in the world
and helps thousands of individual and corporate patients each year. Clinic services include: Treadmill
stress testing, comprehensive laboratory testing, body fat percentage testing, strength and flexibility
testing, weight control and nutrition consultation, women`s preventive services, osteoporosis screening,
FAA certification, sports injury therapy, mental health services, oral cancer screening, nuclear
medicine/CAT scanning. The phone number of The Cooper Clinic(R) is 800-444-5764.
The Cooper Institute for Aerobics Research is known worldwide for its research and education
programs. These include FITNESSGRAM: a fitness and physical activity testing program for children K-12, PALS: a personalized health and lifestyle assessment, corporate work site health promotion programs,
training and certification programs for health, fitness, and medical professionals, and custom
health/fitness newsletters and health education materials. The phone number is 800-635-7050 and this is the
Web site for The Cooper Institue of Aerobics Research.
The Cooper Wellness Program(R) incorporates all elements of The Cooper Aerobics Center with
a powerful, fast-track approach to optimal health. People taking the program will find a supportive, spa-like environment with programs custom designed to rejuvenate and educate participants while
encouraging permanent, positive lifestyle changes. Weight management and smoking cessation
assistance is available. The programs run from one day to two weeks. The phone number is 800-444-5192.
The Cooper Fitness Center(R) provides the finest in athletic/fitness facilities with a professional
service-oriented staff available. For membership information, call 888-964-8875.
The Guest Lodge at the Cooper Aerobics Center is a 63-room European-style hotel. Individuals
attending any of the facilities at The Cooper Aerobics Center can stay at The Guest Lodge during their
visit. All the normal hotel amenities are available including health club privileges. Call 800-444-5187.
My visit to The Cooper Clinic(R)
In Volume 1, Issue 3 of this newsletter, I mentioned the Imatron Ultrafast CT(R) as a non-invasive
test to detect and quantify calcium in the coronary arteries. Some Internet search engines actually
store every word in the documents they search. This fact enabled Mr. Jerry Friede, Director
Cooper Clinic(R) Preventive Imaging, to find that newsletter while searching for information using the
word "Imatron." He wrote me an e-mail to explain that he didn`t realize that there was a men`s
osteoporosis support group and thought we might be interested in his findings. The Cooper Clinic(R) had
been using the Imatron Ultrafast CT(R) and was finding an unexpected number of men with low bone
mineral density. I called the clinic to get more information and was invited to see what they were doing.
I accepted the invitation without delay and scheduled an afternoon visit two days later.
I arrived at the clinic shortly before the 2:00 P.M. appointed time. It is located on Preston Road
which is easily accessible from I-35, I-635, or the Central Expressway. The buildings fit well within the
large grassy area that has many rubber-coated side walks for comfortable jogging. Many of the buildings
and walks are tree-lined, making you forget your closeness to downtown Dallas. The Preventive Imaging
department is upstairs in The Cooper Clinic(R) building where I was greeted by Carl, one of the
technicians with whom I had spoken earlier in the week. He immediately invited me in to see the
Ultrafast CT(R) scanner.
Never having seen a CT scanner before, I didn`t know what to expect. I have had several MRIs
and assumed the Ultrafast CT(R) would be similar. It was, but it did not have the large tomblike cover
that you slide into when having an MRI. Instead, it was a metal ring with some reinforcing structures
around it, that gave me a comfortable open feeling compared to viewing the MRI machine. This scanner
is about ten times faster than the fastest of conventional CT scanners. This speed is necessary to "freeze"
cardiac motion. The radiation for a test is similar to a standard X-ray film of the abdomen. Carl showed
me the supporting equipment that isn`t normally seen by patients and it was impressive. It included
cooling equipment and the control boxes that looked very expensive and complex. We walked back
from the control equipment area and Carl said, "Lift your shirt up, we`ll put some cardiac leads on your
chest and we`ll give you a scan." I wasn`t expecting such a first-hand view of exactly what the machine
did, but I agreed readily because I knew it would be highly educational.
As mentioned, you don`t take any clothes off and, at most, just empty your pockets of metallic
items before lying down on the platform that slides under the ring. Carl showed me the phantom, a
metallic sheet that acts as a density reference when finding bone mineral density. This is placed on the
table under your body and will show up on a scan under your spine, more on this later. He had me lie flat
with my arms over my head holding a plastic bar in somewhat of a chin-up position. This comfortably
keeps the arms out of the way during the scan. He went out of the room and talked to me through a
microphone during the procedure. First he had me hold my breath for about 20-30 seconds as I moved
through the ring from the level of my shoulders to about the lower tip of my sternum. I then had a few
moments to catch my breath before the next scan which was from the last position to my lower abdomen.
The machine repositioned itself while I gained my breath before I held my breath one more time while it
scanned my heart. Carl had explained that the slower the heart beat, the longer you have to hold your
breath since the computer times the exposures when the cardiac leads indicate the heart is resting. This
gives an image like a still frame of the heart and vessels when viewed later. This was the first time I was
sorry about doing aerobic exercise for so long because the time to take the scan had me happy to take a
nice deep breath of air at the end. But, even that was not really uncomfortable, making the overall
procedure as simple as could be expected. The entire scan time was probably just more than a minute,
and the entire time on the table was approximately five minutes. The extra time was taken by setting up
the computer with my name and other information, I presume.
After the scan, I met Mr. Jerry Friede who sat me right down at a large computer monitor and
proceeded to show me what the inside of my upper body looked like. This was fascinating to watch and
very educational. First he showed me the scans of my heart while pointing out the areas where the
various arteries were located. I was happy to say that I saw nothing where he was pointing. Jerry
confirmed my happiness by telling me that my coronary calcification score was zero-as good as it gets. I
was subconsciously thanking myself for almost thirty years of following Dr. Cooper`s exercise and diet
tips. Jerry showed me age-matched tables that would explain the risk of an ischemic coronary event for
that person according to the calcification score they received. For instance, at age 50 if you were in the
zero range, your risk was as low as possible, if you were over about 1,200 your risk was very high. Those
numbers in between would have less risk in accordance with the size of the number. Jerry showed me
scans of people who had coronary artery calcification so I could see what it looked like. The view was
impressive and would certainly get your attention as you watched the computer monitor. He explained
that this was a powerful way to enforce the importance of the need for diet, exercise, medications, and
other means to lower heart attack risk. People who view the image of their own arterial calcification take
the matter seriously. Jerry pointed out that the personal look at my results was not something special for
me, in fact, every person who is scanned at the clinic gets to look at the results of the scan.
How important is coronary artery calcification in contributing to heart attacks? A recent multi-
center study led by John J. Mahmarian, M.D. of the Baylor College of Medicine in Houston, Texas found
that 94% of people experiencing a first heart attack had coronary artery calcification which could have
been detected by the Ultrafast CT(R) scanner. Furthermore, a majority of these individuals had relatively
low calcium scores which suggest that they could not have been detected by other tests such as treadmills
or stress nuclear imaging. The authors concluded that "A lack of coronary calcification therefore
identifies a population at very low risk for coronary artery disease and subsequent cardiac events."
The Ultrafast CT(R) was originally used by The Cooper Clinic(R) and, is apparently being used
elsewhere, solely as a coronary vessel calcification scanner. That means those people only receive(d) the
last scan that I had where scanning was done between beats of the heart. The cost of the multiple scan as
done at The Cooper Clinic(R) is $595. That done elsewhere, consisting of only the heart scan, costs
about $450-495. Jerry Friede noticed that doing only the heart scan limited the usefulness of the results
because so much additional information is available with the two quick additional scans of the chest and
abdomen. Thus, the added scans have been done at The Cooper Clinic(R) for the last couple of years
while they have accumulated data about what has been gained with those scans. From my view, that
extra information is incredibly exciting and I can`t wait for the published results to see exactly what they
found. The next two areas of my scan that we viewed cover that extra information gained by the other
We proceeded to view the internal organs, bones, and other structures that had been scanned. Try
to imagine a hot dog setting on a plate at eye level, and you are viewing its end. You are cutting it into
thin slices and taking a video shot of the hotdog after each slice. Then later you play back the video to
see what was contained within each part of the hot dog. This is roughly what you see of the image of
your body`s insides as you watch the computer monitor. You can start at the tips of your lungs, work to
the middle, and then lower ends. Using the mouse to scroll the information, you can move slowly or as
fast as you want. You see the airways and structure that you associate with normal lung tissue. Then you
follow the esophagus through the lower lung segments and can actually look for hiatal hernias or similar
problems. We also looked at the images of the liver, spleen, pancreas, kidneys, adrenal glands, and other
organs, all with no apparent abnormalities. Jerry explained that using this technique, they had found
dozens of early cancers in the people tested. So far, all of these have led to successful treatment because
the tumors were found before spreading to other parts of the body. Jerry also showed me the lung scan of
a 53-year-old woman smoker. He explained that as she watched the scan she immediately stated that she
was now an ex-smoker. There were no reference images of normal lungs and no one pointed out the
damage to her to help her make that decision. It was purely the power of the images of her own badly
damaged lungs that convinced her.
The last thing we checked was my bone density. As you recall, there was a reference phantom
placed on the table under me while I was scanned. This metallic image was now visible as we found my
lumbar spine. Jerry could actually take a "cut" right through the middle of the vertebra so we were
checking the density of the inner trabecular bone, the most important to evaluate for osteoporosis. Using
our hot dog reference above, it was as though the skin of the hot dog was the thick cortical bone and the
inside of it was the trabecular bone. He then drew out a reference box using the mouse, compared that to
one on the phantom, and the computerized results were matched to give a percent of bone loss. My
results showed 83% of normal BMD and my most recent DEXA showed 86% of normal. According to
Jerry, this is to be expected since this is a more sensitive test of bone mineral density. The DEXA is a
posterior-anterior x-ray that must include all the cortical bone, arthritic bone, abnormal soft tissue
calcifications, etc. These should lead to a slightly greater appearing bone density than the test on my
spine that only included trabecular bone.
The addition of the bone density test to the Ultrafast CT(R) scan results at The Cooper Clinic(R)
has shown an unexpected high rate of low bone mineral density in the "normal" males that have been
tested so far. The exact results will be published later, but some general figures are available now. From
tests of about 5,000 men, in those aged 55-59, about 25% have low bone density and half of those have
density below the fracture range. By ages 65-69 that number doubles: 50% have low bone density and
half of those have readings below the fracture range. Jerry says that, although hormonal abnormalities
and steroidal anti-inflammatory drug use account for some of the cases, the vast majority of cases appear
related to calcium deficiency, physical inactivity, and (sometimes) smoking. They have often found that
many general medical practitioners don`t accept the idea that their male patients have osteoporosis and
don`t adequately treat the condition. They recommend that men seek out an endocrinologist or other
physician specializing in osteoporosis if their physician does not take the finding seriously. It was
pointed out that several men have been treated with Fosamax and have shown significant increases in
bone mineral density in a one-year follow-up test.
We were viewing my results in the back of the lab near the scanner. Jerry took me to the front
where people normally see their scans in a nicely appointed room that also has the large computer
monitor and comfortable chairs to sit in while viewing the results. There are several pamphlets with
diagrams and charts to explain the results and risks at each step of the explanation. They have found that
compliance with recommendations for diet and exercise modification are excellent and feel that this is
largely attributable to the first-hand viewing of the data rather than sending written results as is often
done after x-rays, MRIs, or CT scans. I know that I found viewing my results both fascinating and
powerful. Had coronary calcifications been present, it would have gotten my attention without a doubt.
One interesting observation that Jerry noted was that so far in their tests serious weight lifters do
not show osteoporosis. These men tested generally use moderate to heavy weights at least
three times a week. There have been many T-scores (age-matched bone density) that are +1-2
standard deviations above normal. He points out that weight lifting must be done properly to avoid injury
or degenerative changes and those with back problems should be cleared by a physician and learn proper
technique from a certified trainer (most are not certified). Those with severe osteoporosis should take
care not to over lift as that may cause vertebral compression fractures. Slowly increasing the weight used
while strengthening bones with calcium, Vitamin D, and often Fosamax would be reasonable. Anyone
with chest pains or existing heart disease should obviously not take up new exercise until cleared by a
physician and anyone with high blood pressure should have that condition controlled first.
I was concerned about insurance coverage of the test. Jerry says that many insurance companies
do cover the test. Usually there needs to be a diagnosis for insurance to cover, i.e., chest pain or
discomfort, shortness of breath, osteoporosis, abdominal pain, back pain, etc. Most insurance companies
also require a physician`s referral.
In the people tested so far, there appears to be a definite correlation between patients with
osteoporosis and coronary atherosclerosis. There are, however, many exceptions and the relationship
most probably reflects the fact that many people who develop both conditions have a propensity toward
poor diet and exercise habits.
I had wondered about the use of the Ultrafast CT(R) to also scan for carotid artery calcifications
in the neck as an additional scan. Jerry said that ultrasound does such a good job of carotid artery
imaging that it is felt to be the method of choice. They do often recommend the carotid ultrasound when
there is substantial coronary and/or aortic calcification that shows up in the scan.
An interesting aspect of the tests is that after coronary calcifications are found, subsequent annual
tests can be done to monitor results. The great part of this monitoring is that the test is non-invasive and
objective, and the person can actually view the changes or lack thereof in arterial calcification and/or
bone density. Jerry says they expect to see increased bone mineral density at follow-up on patients that
start therapy after being diagnosed with osteopenia or osteoporosis. They, however, really do not expect
to see regression in calcified plaque, but what they look for is a lack of progression (stability). Their data
shows that patients with above normal calcification for their age will progress quite rapidly without
treatment. When treatment to lower LDL cholesterol is implemented, progression slows dramatically and
sometimes stops completely.
The published results of all the details contained in the data from thousands of scans at The
Cooper Clinic(R) should have interesting ramifications. It is hoped they will give guidance as to who
would benefit most from a scan with the Ultrafast CT(R) using The Cooper Clinic(R) method. If the
results are dramatic enough, it may cause other testing facilities to add the two additional scans to a
normal test rather than only doing the heart scan. Additionally, it would be important to have objective
data describing the importance of needed follow-up examinations, perhaps based upon age and conditions
diagnosed in the original scan. Of course, the final picture of the rates of osteopenia and osteoporosis in
the sample of men should be very interesting. The men who attend The Cooper Clinic(R) undergo a very
thorough physical and provide a detailed personal history, including diet, exercise, and other factors that
might be important to elucidating the source of the low bone mineral density in the men tested. If
testosterone levels are tested, that might provide further information as to the cause of the men`s low
bone mineral density. If these factors can be correlated with the causes of low bone mineral density in
tested men, there should be additional information available to help men prevent osteoporosis, obviously
more desirable than treating it after it occurs.
The Ultrafast CT(R), as used at The Cooper Clinic(R), appears to have tremendous potential to
diagnosis multiple serious problems with a thorough, quick, and non-invasive test. As pointed
out, there is strong evidence that the finding of coronary artery calcification identifies that
person as someone at risk for heart attack. Realizing that heart attack risk is present, that individual can
then take advantage of all that is known to reduce their risk by diet, exercise, and medications. Annual
heart scans thereafter will attest to the effectiveness of therapy. The importance of the other scans would
be readily agreed upon by all in whom early cancers and low bone mineral density were detected by those
scans. The significance of the findings on the percentage of "normal" men with low bone mineral
density who have taken the test is yet to be fully described. The future publication of the results appears
to have the potential to change the view that males are generally not expected to be candidates for
osteopenia or osteoporosis, that being solely the worry of women. As soon as these final results are
available, I will summarize them in this newsletter.
Diagnosis and treatment of osteoporosis are the responsibility of the patient and his or her
physician. Nothing in this newsletter is to be interpreted as a recommendation for treatment
or to change treatment that your physician has prescribed. Although we attempt to assure that
information in this newsletter is factual, errors will occur. It is the responsibility of the reader to verify
that information they are acting on is factual. There is no relationship between this newsletter and any
national osteoporosis group, including the National Osteoporosis Foundation. All references to any such
groups are for informational purposes only.