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Why Is Screening For Osteoporosis In Postmenopausal Women Important?

From the U.S. Preventive Services Task Force (USPSTF)

Osteoporosis is a condition marked by thinning and weakening of bones and can lead to fractures, loss of height due to compression of the bones in the spine, and pain. Currently, osteoporosis is most commonly diagnosed by finding an abnormal result on X-rays that measure bone mineral density.

Osteoporosis and fracture are most common in older women and are due to gradual loss of bone after menopause. Fifty percent of all women who live to be 85 years of age will have an osteoporosis-related fracture during their lives; 25% of these women will develop a deformity of the spine, and 15% will fracture a hip. Screening women at risk for osteoporosis can lead to early detection and treatment, thus preventing fractures.

Who Is At Risk For Osteoporosis?

Women are at greater risk for osteoporosis and fracture than men are because women's bones are less dense than men's bones. Risk for osteoporosis increases steadily and substantially with age. Women 65 or older are at greatest risk. Lower body weight is also consistently associated with osteoporosis, but to a lesser degree than age. Women weighing less than 132 pounds are at greatest risk; women 60 and older who weigh less than 154 pounds are at increased risk.

What Does The USPSTF Recommend?

The USPSTF recommends that women 65 and older be screened routinely for osteoporosis. For women at high risk for fractures, the USPSTF recommends that screening begin at age 60.

The USPSTF makes no recommendation for or against routine osteoporosis screening in postmenopausal women who are younger than 60 or in women aged 60-64 who are not at increased risk for osteoporotic fractures.

What Screening Tests Are Available?

Dual-energy x-ray absorptiometry (DXA) of the hip is the best predictor of hip fracture and is comparable to forearm measurements for predicting fractures at other sites. Using DXA to measure bone density of the hand, wrist, forearm, and heel also appears to detect women who are at increased risk for fracture.

Other tests to measure bone mineral density of the hand, heel, wrist, and forearm include include single photon absorptiometry, quantitative computed tomography, single-energy x-ray absorptiometry, and peripheral quantitative computed tomography.

What Treatments Are Available?

Bisphosphonates, such as alendronate and risedronate; selective estrogen-receptor modulators (SERMs), such as raloxifene; calcitonin; and estrogen can improve bone density and reduce risk for fractures. Each of these treatments has potential benefits and harms. Clinicians should discuss these with their patients and help them decide which treatment is best for them. Treatment will be more beneficial in women who have more risk factors for fracture, such as those who are older, have very low bone density, or have pre-existing vertebral fractures.

Last updated September 13, 2010




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