Osteoporosis screening
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Osteoporosis Microchapters |
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Diagnosis |
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Osteoporosis screening On the Web |
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American Roentgen Ray Society Images of 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: Eiman Ghaffarpasand, M.D. [2]
Overview
The risk of fracture due to osteoporosis is threatening; one out of two postmenopausal women and also one out of five older men. The 10-year risk for any osteoporosis-related fractures in a 65-year-old white woman with no other risk factor is 9.3%. According to the guidelines of USPSTF, all women ≥ 65 years old along with women < 65 years old with a high risk of fracture are the target of screening for osteoporosis, but there is not any recommendation to screen men for the disease. There are two major methods, suggested for screening osteoporosis, that include; dual energy x-ray absorptiometry (DXA) of both hip and lumbar spine bones, and quantitative ultrasonography of the calcaneus.
Screening
Risk assessment
The risk of fracture due to osteoporosis is threatening; one out of two postmenopausal women and also one out of five older men. Osteoporosis usually affects the white population. The rate of osteoporosis is higher in elderly. The 10-year risk for any osteoporosis-related fractures in a 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 into three groups, categorizing them on the basis of their need to be screened for osteoporosis; they include:
- Women of age ≥ 65 year, without any fracture history or pathological reason for osteoporosis
- Women of age <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 history of osteoporosis
According to the guidelines of USPSTF, the former two groups (women) are the target of screening for osteoporosis; but there is not any recommendation to screen the third group (men) for the disease.[1]
The USPSTF recommendations from 2002 included:
- 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 the 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 are suggested to be used for screening for osteoporosis:
- Dual energy x-ray absorptiometry (DXA) of both hip and lumbar spine bones
- Quantitative ultrasonography of the calcaneus
Advantages of ultrasonography over DXA scan:
Although quantitative ultrasonography has numerous advantages when compared to DXA but still current diagnostic and treatment criteria rely on DXA of the hip and lumbar spine. The advantages include:
- Lower cost
- More portable
- Lower ionizing radiation exposure
Screening protocol
After an initial screening is done for bone mineral density (BMD), optimal intervals to repeat the tests may include:
- 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]
Osteoporosis Screening Recommendations by other Organizations
| Organizations | Women | Men |
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| National Osteoporosis Foundation (NOF) [6] | BMD testing for:
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BMD testing for:
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| World Health Organization (WHO) [7] | Indirect records suggest screening women ≥65 years old, while no direct record suggests using BMD testing for holistic screening programs | - |
| American College of Physicians [8] | - |
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| American Congress of Obstetricians and Gynecologists (ACOG) [9] | BMD testing for:
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§ Fracture risk profiles are as the table below.[10]
| Adults ≥ 40 years of age | Adults <40 years of age | |
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| High fracture risk |
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| Moderate fracture risk |
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or and
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| Low fracture risk |
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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, Ransohoff DF, Cauley JA, Ensrud KE (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.
- ↑ Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S; et al. (2014). "Clinician's Guide to Prevention and Treatment of Osteoporosis". Osteoporos Int. 25 (10): 2359–81. doi:10.1007/s00198-014-2794-2. PMC 4176573. PMID 25182228.
- ↑ "www.euro.who.int" (PDF).
- ↑ Qaseem A, Snow V, Shekelle P, Hopkins R, Forciea MA, Owens DK (2008). "Screening for osteoporosis in men: a clinical practice guideline from the American College of Physicians". Ann. Intern. Med. 148 (9): 680–4. PMID 18458281.
- ↑ "ACOG Practice Bulletin N. 129. Osteoporosis". Obstet Gynecol. 120 (3): 718–34. 2012. doi:10.1097/AOG.0b013e31826dc446. PMID 22914492.
- ↑ Buckley, Lenore; Guyatt, Gordon; Fink, Howard A.; Cannon, Michael; Grossman, Jennifer; Hansen, Karen E.; Humphrey, Mary Beth; Lane, Nancy E.; Magrey, Marina; Miller, Marc; Morrison, Lake; Rao, Madhumathi; Robinson, Angela Byun; Saha, Sumona; Wolver, Susan; Bannuru, Raveendhara R.; Vaysbrot, Elizaveta; Osani, Mikala; Turgunbaev, Marat; Miller, Amy S.; McAlindon, Timothy (2017). "2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis". Arthritis & Rheumatology. 69 (8): 1521–1537. doi:10.1002/art.40137. ISSN 2326-5191.