Osteoporosis screening
|
Osteoporosis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Medical Therapy |
|
Case Studies |
|
Osteoporosis screening On the Web |
|
American Roentgen Ray Society Images of Osteoporosis screening |
|
Risk calculators and risk factors for Osteoporosis screening |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2], Raviteja Guddeti, M.B.B.S.[3]
Overview
Osteoporosis is common in people 65 years and older. Bone turnover is unbalanced in elderly individuals, especially in females because of the lack of estrogen after menopause. The US Preventive Services Task Force (USPSTF) recommends that all women 65 and older be screened with a DEXA scan.
Screening
The US Preventive Services Task Force (USPSTF) in 2011 recommends screening for osteoporosis among:[1]
- Women whore more than 65 years of age
- Women who are less than 65 years of age among whom the risk of fracture is ≥ than that of white women 65 years of age and with no additional risk factors.
The 10-year risk for any osteoporotic fracture is 9.3% and can be estimated by the FRAX tool. In addition, according to the 2011 USPSTF recommendations, there is insufficient evidence for the benefits and harms of screening for osteoporosis among men.
Prior USPSTF recommendations from 2002 were:
- All women 65 and older be screened with bone densitometry.[2]
- The Task Force recommends screening women aged 60 to 64 who are at increased risk. The most significant risk factor for indicating an increased probability of having osteoporosis is lower body weight (weight < 70 kg).
- Clinical prediction rules are available to guide selection of women for screening. The Osteoporosis Risk Assessment Instrument (ORAI) may be the most sensitive strategy.[3] The ORAI is available online at http://osteoed.org/tools.php?type=orai.
- Regarding the screening of men, a cost-analysis study suggests that screening may be "cost-effective for men with a self-reported prior fracture beginning at age 65 years and for men 80 years and older with no prior fracture".[4]
After an initial screening bone mineral density, optimal intervals to repeat densitometry may be:[5]
- "15 years for women with normal bone density or mild osteopenia (T score, greater than −1.50)"
- "5 years for women with moderate osteopenia (T score, −1.50 to −1.99)"
- "1 year for women with advanced osteopenia (T score, −2.00 to −2.49)"
References
- ↑ U.S. Preventive Services Task Force (2011). "Screening for osteoporosis: U.S. preventive services task force recommendation statement". Ann Intern Med. 154 (5): 356–64. doi:10.7326/0003-4819-154-5-201103010-00307. PMID 21242341.
- ↑ U.S. Preventive Services Task Force (2002). "Screening for osteoporosis in postmenopausal women: recommendations and rationale". Ann. Intern. Med. 137 (6): 526–8. PMID 12230355.
- ↑ Martínez-Aguilà D, Gómez-Vaquero C, Rozadilla A, Romera M, Narváez J, Nolla JM (2007). "Decision rules for selecting women for bone mineral density testing: application in postmenopausal women referred to a bone densitometry unit". J. Rheumatol. 34 (6): 1307–12. PMID 17552058.
- ↑ Schousboe JT, Taylor BC, Fink HA; et al. (2007). "Cost-effectiveness of bone densitometry followed by treatment of osteoporosis in older men". JAMA. 298 (6): 629–37. doi:10.1001/jama.298.6.629. PMID 17684185.
- ↑ Gourlay ML, Fine JP, Preisser JS, May RC, Li C, Lui LY; et al. (2012). "Bone-density testing interval and transition to osteoporosis in older women". N Engl J Med. 366 (3): 225–33. doi:10.1056/NEJMoa1107142. PMC 3285114. PMID 22256806.