Should You Be Tested for Osteoporosis?
by Sophia Cariati
(Washington DC, 12/5/02): 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 US 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 US 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 US 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
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.
The Society for Women's
Health Research is the nation's only not-for-profit organization
whose sole mission is to improve the health of women through research. Founded
in 1990, the Society brought to national attention the need for the appropriate
inclusion of women in major medical research studies and the resulting need
for more information about conditions affecting women. The Society advocates
increased funding for research on women's health, encourages the study of sex
differences that may affect the prevention, diagnosis and treatment of disease,
and promotes the inclusion of women in medical research studies. Dr. Donnica
Moore has been a member of the Society since 1990 and is a past member of its
Board of Directors.
For more information on
osteoporosis, click here.
Created: 12/5/2002  - Sophia Cariati