Should You Be Tested for Osteoporosis?

December 6, 2002

(Society for Women's Health Research) -- All women 65 and older, as well as those aged 60 to 64 with risk factors, should be routinely screened for osteoporosis, according to a recent recommendation of the U.S. Preventive Services Task Force, marking the first time this influential group has called for routine bone testing.

"This is a tremendous step forward for the improved detection of this silent disease," said Ethel Siris, MD, director of the Toni Stabile Center for the Prevention and Treatment of Osteoporosis at the Columbia-Presbyterian Medical Center in New York City. "The U.S. government has basically mandated that all women who fall into this category should receive bone mineral density (BMD) testing as a screen for osteoporosis."

For the most part, women and their physicians are just beginning to recognize that bone density testing is as important as screenings like mammograms and Pap smears, according to Dr. Siris. "Osteoporosis is a relatively new public health issue and has only recently been on the public's mind," says Dr. Siris. "My hope is that the Task Force recommendation will help increase awareness so that women appropriately request osteoporosis screening and their primary care doctors get this important issue on their radar screens."

Osteoporosis is an often silent condition in which bone tissue thins or develops small holes. Left untreated, osteoporosis can worsen painlessly until a fracture occurs. While all bones are affected, hip, spine and wrist fractures are the most common. Hip fractures after age 50 are of special concern as they often lead to loss of independence and are associated with a more than 20 percent increased risk of death in the year following the fracture.

Since age is the single greatest risk factor for osteoporosis, the Task Force concluded that screening those 65 years and older would prevent the largest number of fractures. In addition, women aged 60 to 64 who weigh less than 154 pounds and are not taking estrogen should be screened routinely, according to the guidelines published in the September 17, 2002 issue of the Annals of Internal Medicine. The group advised physicians to use their own judgment in deciding whether or not to test women under 60 and those without risk factors.

Citing lack of evidence, the Task Force stopped short of recommending any one specific BMD test. They did note that dual-energy x-ray absorptiometry (DEXA) is the most accurate method. However, a cheaper and more portable method that tests so-called peripheral bone density at the hand, wrist, forearm and heel was also shown to be an accurate way of predicting fracture risk. BMD screenings should be performed no more frequently than every two years.

Half of Postmenopausal Women Unaware of Brittle Bones
Only an estimated 12 percent of women over the age of 65 have received a BMD test, according to the National Osteoporosis Foundation. The failure to perform regular bone density testing has left many women unknowingly at risk for fractures. A recent study conducted by Dr. Siris and colleagues confirms that many postmenopausal women have brittle bones and don't know it.

In the largest U.S. study of osteoporosis conducted to date, more than 200,000 postmenopausal women aged 50 and older underwent bone density screening. Almost half of the women were found to have previously undiagnosed low bone density levels, putting them at increased risk for fracture. Close to 40 percent of these women had brittle bones while 7 percent had full-blown osteoporosis. Equally disturbing is that 11 percent of study participants had suffered a fracture since age 45 but none had been diagnosed or treated for thinning bones.

"These findings are a wake up call to all primary care physicians," says Dr. Siris. "They clearly show that the only way we can detect this silent, asymptomatic disease is by using the available screening tools in the first place."

Women, who are four times more likely than men to develop osteoporosis, make up eight million of the 10 million Americans estimated to have the disease, according to the National Osteoporosis Foundation. An additional 34 million individuals are estimated to have low bone mass, putting them at risk for osteoporosis. As the population becomes increasingly elderly over the next few decades, the number of Americans at risk for osteoporosis is expected to jump markedly.

Sarah Keitt, MPH, a scientific program manager for the Society for Women's Health Research, said osteoporosis is a leading risk factor for hip fracture in elderly women.

"Many elderly women who survive hip fractures due to osteoporosis suffer a significant compromise in quality of life," says Keitt. "Statistics show that about one-fifth of hip fracture patients require long-term nursing home care, and 10 percent remain functionally dependent upon daily living care."

Studies show that more than half of all osteoporosis- related fractures can be prevented through early diagnosis and treatment of low bone mass. Lifestyle changes such as starting an exercise plan, increasing calcium and vitamin D intake via supplements or diet, and smoking cessation can all improve bone density. Medical treatments including hormone replacement therapy, raloxifene, calcitonin, bisphosphonates, and selective-estrogen receptor modulators have also been shown to be effective at reducing the risk of fractures. Women should talk to their doctors about which treatment is best for them.