New osteoporosis screening guidelines

Osteoporosis is a condition associated with low bone mineral density (BMD) resulting in increased risk for fractures. According to the National Osteoporosis Foundation, as many as 10 million people in the U.S. have osteoporosis and almost 34 million are at risk. When detected by screening measures, treatment of osteoporosis has been shown to decrease the risk of developing an osteoporosis-related fracture.

The US Preventive Services Task Force (USPSTF) is a respected panel of health care experts who review the current medical literature to develop scientifically based screening guidelines for a variety of medical conditions. One of the conditions for which it has issued screening guidelines is osteoporosis, the last time being in 2002. At that time, they recommended bone density screening for women 65 years or older and for women aged 60 to 64 years at increased risk for osteoporotic fractures. In that report, there were no recommendations regarding screening postmenopausal women younger than 60 years or women aged 60 to 64 years who did not have an increased risk for fractures.

As is the case with many diseases, screening guidelines can change based on new scientific evidence. Following a review of osteoporosis-related research published since 2002, the USPSTF released new screening guidelines, which updated their previous recommendations. Here are several important points drawn from their most recent report:

1. Starting at age 65, all women should undergo screening for osteoporosis. This applies to women of all racial and ethnic groups. The USPSTF did not define a specific upper age limit for screening in women because the risk for fractures continues to increase with age.
   


2. In women between ages 50 and 64, the need for testing is based on their risk of breaking a bone due to osteoporosis over the next ten years. Screening is recommended if this risk equals that of a 65-year-old white woman who has no additional risk factors. Those risk factors include a family history of osteoporosis, low body weight, and alcohol abuse.
   


3. The USPSTF recommends the use of the FRAX formula to estimate a woman’s 10-year risk of sustaining an osteoporosis fracture. This tool uses clinical information, such as age, body mass index (BMI), parental fracture history, and tobacco and alcohol use to determine the risk of fracture. Bone density screening is recommended in women aged 50 to 64 years with a 9.3% or greater 10-year fracture risk.
   


4. The most common methods of screening for osteoporosis are dual-energy x-ray absorptiometry (DXA scan) of the hip and lumbar spine and quantitative ultrasonography of the calcaneus. While both methods can predict fractures accurately, the DXA has become the gold standard for the diagnosis of osteoporosis and for guiding decisions about which patients to treat.
   


5. The optimal time interval for performing screening tests has not yet been determined. It appears, however, that at least 2 years between screenings is necessary to reliably measure a change in bone mineral density (BMD), and even longer intervals may be necessary to improve fracture risk prediction.
   


6. According to the USPSTF, there is not enough current evidence to recommend screening for osteoporosis in men. This is in contrast to the National Osteoporosis Foundation’s recommendation that BMD testing should be done in all men at 70 years of age or in the 50-69 year age group if they areat high risk for a fracture.
   

It has been estimated that by the year 2012, approximately 12 million Americans over the age of 50 will have osteoporosis. Detecting low bone mineral density through screening provides an opportunity to prevent osteoporosis-related fractures. The USPSTF found convincing evidence that treatment of osteoporosis can reduce subsequent fracture rates in postmenopausal women. In addition to adequate calcium and vitamin D intake and weight-bearing exercise, several medications are approved by the U.S. Food and Drug Administration to reduce fractures, including bisphosphonates, parathyroid hormone, raloxifene, and estrogen.