Screening Tests for Adults (50 and Up)

Finding out if your bones have become dangerously porous and treating the problem can help reduce your risk of a fracture. An industry-funded study in 2001 estimated that only 12 percent of women 65 years of age or older with osteoporosis or osteopenia (low bone mass) had a Medicare-reimbursed bone marrow density x-ray. Your health care provider can now also use a calculator, called the FRAX tool, to better determine your risk of a hip, wrist, shoulder, or spine fracture after age 40. Available online or on paper, the calculator, developed by the World Health Organization, considers the bone density measurement and 9 other risk factors.

The National Osteoporosis Foundation recommends screening adults (men and women) as follows:

• Men older than 70 years should be screened.
• Women older than 65 years of age should be screened.
• Adults who are middle aged and at risk should be screened. (For example, if they have already broken one of their bones as an adult, have a family history of osteoporosis or broken bones, use tobacco, or weigh less than 127 pounds. Other risk factors include physical inactivity and certain medications and therapies.)

Osteoporosis screening guidelines for men published in May 2008 by the American College of Physicians point out that this condition is underdiagnosed in men. Their guidelines include recommendations that risk assessments be periodically performed for all men starting before age 65 and that dual-energy x-ray absorptiometry be used to screen those men determined to be at increased risk of osteoporosis who are candidates for drug therapy. Risk factors include age over 70, low body weight and recent weight loss, physical inactivity, corticosteroid use, androgen deprivation therapy, and previous fragility fracture.

Older women benefit the most from screening for osteoporosis, the experts tend to think. Prevention efforts ideally begin in adolescence and young adulthood. After menopause, women need to be on the lookout for brittle bones and their susceptibility to fracture. Many government and medical organizations agree on the following:

• Women 65 years of age and older should have their bone mass measured.

Screening after menopause is also appropriate for some younger women:

• Younger women who have gone through menopause (which usually occurs between 45 to 55 years of age) and are at risk of a fracture due to porous bone benefit from screening.

Note that taking certain medications or having certain medical and physical conditions adds to your risk. Your health care provider can assess your risk and advise you on exercise and balance training, how to get the calcium your bones need, and ways to avoid smoking and appropriately limit your alcohol consumption. These steps help slow the loss of bone mass that occurs with aging.

How long to wait before getting re-tested hasn’t been firmly established, but how dense your bones are may be a factor. The National Osteoporosis Foundation says re-testing is usually done after 2 years. Ask your health care provider for current information.

Sources

US Department of Health and Human Services. Bone health and osteoporosis: a report of the surgeon general (2004). Available on the Internet at http://www.surgeongeneral.gov/library/bonehealth through http://www.surgeongeneral.gov. Accessed 19 Feb 2008.

National Osteoporosis Foundation. Bone tool kit. 2007. PDF available for download at http://www.nof.org/awareness2/2007/images/Bone_Tool_Kit.pdf through http://www.nof.org. Accessed 19 Feb 2008.

California Department of Health Services Osteoporosis Prevention and Education Program, Chronic Disease Control Branch. California’s action plan to prevent osteoporosis: 2005-2015. Available on the Internet at http://www.dhs.ca.gov/CDIC/cdcb/Medicine/Gerontology/OAUnit through http://www.dhs.ca.gov. Accessed 20 Feb 2008.

National Osteoporosis Foundation. Clinician’s guide to prevention and treatment of osteoporosis. 2008. Available on the Internet at http://www.nof.org/professionals/Clinicians_Guide.htm through http://www.nof.org. Accessed 26 Feb 2008.

World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, United Kingdom. FRAX WHO fracture risk assessment tool. Available on the Internet at http://www.shef.ac.uk/FRAX through http://www.shef.ac.uk. Accessed 26 Feb 2008.

Amir Qaseem, MD, PhD, MHA et al. for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Screening for Osteoporosis in Men: A Clinical Practice Guideline from the American College of Physicians. Annals of Internal Medicine 6 May 2008. Volume 148, Issue 9. Pages 680-684.

National Osteoporosis Foundation. Physician’s guide to prevention and treatment of osteoporosis. 2003. Available on the Internet at http://www.nof.org/physguide through http://www.nof.org. Accessed 19 Feb 2008.

Raisz, LG. 14 Jul 2005. Screening for Osteoporosis. N Engl J Med 353;2:164-171. PDF available for download at http://www.temple.edu/iimreports/ReadingList/Miscscreening-for-Osteoporosis-NEJM-2005.pdf through http://www.temple.edu. Accessed 13 Mar 2008.

Berg AO, for the US Preventive Services Task Force. Screening for osteoporosis in postmenopausal women: recommendations and rationale. Jan 2003. Am J Nursing 103(1):73-80. Available on the Internet through http://www.guideline.gov. Accessed 19 Jul 2004 and 19 Feb 2008.

National Osteoporosis Foundation. NOF applauds USPSTF recommendation on BMD tests (press release). 16 Sep 2002. Previously available on the Internet at http://www.nof.org/news/pressreleases/uspstf_02.html. Accessed 19 Jul 2004; document no longer posted.