Osteoporosis screening
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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
Risk assessment
Today, risk of fracture due to osteoporosis is threatening one out of two postmenopausal women and also one out of five older men. Leading ethnicity involved in osteoporosis is white. The rate of osteoporosis is higher in elderly. The 10-year risk for any osteoporosis-related fractures in 65-year-old white woman with no other risk factor is 9.3%. The 10-year probability of hip fracture can be estimated by the FRAX tool based on the presence or absence of clinical risk factors in addition to the bone mineral density (BMD) at the femoral neck.
Screening criteria
The US Preventive Services Task Force (USPSTF) divides the population to three groups, categorize their need to be screened for osteoporosis; they include:
- Women of 65 years and older, without any fracture history or pathological reason for osteoporosis
- Women of less than 65 years, with 10-year fracture risk of not less than a 65-year-old white woman (who has not any other risk factor)
- Men with no osteoporosis history
Upon the guidelines of USPSTF, the former two groups (women) are target of screening for osteoporosis; but there is not any recommendation to screen the third group (men) for the disease.[1]
Prior USPSTF recommendations from 2002 were include:
- All women of 65 and older should be screened by bone marrow densitometry.[2]
- The USPSTF recommends screening women aged 60-64 years old, who are at increased risk of fracture. The most significant risk factor for indicating an increased probability of having osteoporosis is lower body 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]
- Regarding the screening process for 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]
Screening tool
There are two major methods, that is suggested to use for screening osteoporosis; they include:
- Dual energy x-ray absorptiometry (DXA) of both hip and lumbar spine bones
- Quantitative ultrasonography of the calcaneus
Although quantitative ultrasonography has lower price, more portability, lower ionizing radiation exposure for patients, and otherwise the same power of fracture prediction (in femoral neck, hip, and spine) comparing with DXA method, current diagnostic and treatment criteria rely on DXA of the hip and lumbar spine.
Screening protocol
After an initial screening bone mineral density (BMD), optimal intervals to repeat the test may include the followings:
- 15 years for women with normal bone density or mild osteopenia: T-score of greater than −1.50
- 5 years for women with moderate osteopenia: T-score of −1.50 to −1.99
- 1 year for women with advanced osteopenia: T-score of −2.00 to −2.49 [5]
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.