USPSTF recommends densitometry screening for some women younger than 65
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| Dual energy x-ray absorptiometry scan of the lumbar spine in a 37-year old woman with lumbar spine osteopenia. Image source: BoneDensitometers.com |
In 2002, the USPSTF recommended bone density testing for women 65 years or older and women 60 to 64 years with increased fracture risk and made no recommendation for or against screening other women or men.
Based on a review of the clinical data through 2009, Heidi D. Nelson, MD, from the Oregon Health & Science University and Providence Health & Services in Portland, Ore., and colleagues noted that dual-energy x-ray absorptiometry (DEXA) predicts fractures similarly for men and women; calcaneal quantitative ultrasonography also predicts fractures, but correlation with DEXA is low. For postmenopausal women, bisphosphonates, parathyroid hormone, raloxifene and estrogen reduce primary vertebral fractures.
To determine the influence of risk factors in selecting women for densitometry screening, the task force estimated 10-year risks for major osteoporotic and hip fractures for U.S. white women by using the online FRAX calculator (www.shef.ac.uk/FRAX/).
By using risk estimates for women aged 65 years with no additional risk factors as the reference case (9.3 percent risk for osteoporotic and 1.2 percent risk for hip fractures), the USPSTF identified age-specific (expressed five-year intervals) and risk factor-specific categories of women (including osteoporotic fractures, hip fractures and body mass index) with similar or higher-risk estimates.
“Some women younger than 65 years with risk factors exceed the risk equivalents of the reference case,” they wrote. “These estimates may be useful in selecting candidates for densitometry screening.”
The USPSTF said that the results of densitometry further characterize fracture risk and are useful in determining the appropriateness of medication. Trials support the efficacy of medications to prevent primary fractures only for women with bone mineral density (BMD) T-scores of -2.5 or less.
Incidentally, they also found that prevention trials are lacking in men. However, one study of BMD and risk for hip and nonvertebral fractures compared men enrolled in MrOS (Osteoporotic Fractures in Men Study) with women in SOF (Study of Osteoporotic Fractures) and reported similar results. However, in this study, DEXA of the femoral neck was associated with a higher relative risk for hip fracture in men (3.68) than in women (2.48). Additional studies are consistent with findings from the Rotterdam Study and MrOS, according to the authors.