February 23, 2011

New Osteoporosis Screening Guidelines

The guidelines for osteoporosis screening have been expanded — do they include you?

Officials from the Unites States Preventative Services Task Force (USPSTF) have recently announced expanded guidelines for osteoporosis screening in women. The recommendations now include women who are younger than 65, and whose lifestyles or family histories put them at higher risk.

A 60-year-old woman who drinks alcohol daily and has a BMI less than 21 kg/m2 or smokes cigarettes would also be at higher risk and should be screened.

According to officials, all women over 65 should be screened, no matter their individual risk or family history. In addition, younger women whose risk level is as high as a 65-year-old should also be screened. Risk factors aside from age include family history, smoking, alcohol use, and having a low body mass index (BMI).

The risk of bone fracture for a white women over 65 with no other risk factors is about 9.3% over 10 years. The USPSTF statement gives some examples of profiles that would put a younger woman at the same risk. For instance, a 50-year-old woman who smokes, drinks alcohol daily, has a BMI of less than 21 kg/m2, and has a parent with osteoporosis has the same risk level as the healthy 65-year-old. Similarly, a 60-year-old woman who drinks alcohol daily and has a BMI less than 21 kg/m2 or smokes cigarettes would also be at higher risk and should be screened. The statement also reminds us that white women have a slightly higher risk level than nonwhite women.

According to the statement, not enough information is available to make recommendations for screening in men at this time. The National Osteoporosis Foundation (NOF) currently recommends that all men over 70 be screened, as well as those 50-69 who have additional risk factors.

The most common tests for osteoporosis are the dual-energy x-ray absorptiometry, or DXA, which looks at the lower spine and hip bones, and ultrasound of the heel. Treatments for osteoporosis include taking calcium and vitamin D supplements, engaging in weight-bearing exercise, and using prescription therapies, like bisphosphonates, estrogen, parathyroid hormone, and raloxifene.

Half of all women will experience a bone fracture due to osteoporosis — for men, this number is about one in five. Hip fractures, which are common, are linked to serious health issues and even death, and fractures in other bones can also severely compromise quality of life, according to the study. One-third of men who have a hip fracture will die within the following year. Therefore, screening and proper treatment are extremely important for both sexes.

If you are concerned about your risk for osteoporosis, talk with your doctor about your specific risk factors to determine whether or not screening is necessary.

The statement was published in the January 17, 2011 issue of Annals of Internal Medicine. For more information from the NOF see: http://www.nof.org/home.

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