NEJM: Osteo screening interval can be extended to 15 years for many
Bone mineral density (BMD) screening for osteoporosis should be necessary only every 15 years for postmenopausal women with normal bone density on an initial test, though the screening interval for women with advanced osteopenia should be reduced to one year, according to a study published in the Jan. 19 issue of the New England Journal of Medicine.
BMD screening using dual-energy x-ray absorptiometry is recommended for women aged 65 and older. However, no prior guidelines specified an appropriate testing interval, according to Margaret L. Gourlay, MD, of the University of North Carolina in Chapel Hill, and colleagues. The authors noted that the U.S. Preventive Services Task Force suggested that screening intervals as short as two years may be necessary, yet no U.S. study had specifically addressed the issue.
The researchers defined the testing interval as the estimated time during which osteoporosis developed in 10 percent of women before they had a hip or clinical vertebral fracture and before they were treated for osteoporosis. Data came from a 15-year longitudinal study of 4,957 women, aged 67 or older, without osteoporosis at baseline.
Results showed that the estimated BMD testing interval for women with normal BMD (T score of -1 or higher) was 16.8 years. In women with osteopenia (T score of -1.01 to -2.49), BMD testing intervals were shorter: 4.7 years for women with moderate osteopenia and 1.1 years for women with advanced osteopenia.
“Our results suggest that the baseline T score is the most important determinant of a BMD testing interval,” wrote the authors. “During the 15-year study period, less than 1 percent of women with T scores indicating normal BMD and 5 percent of women with T scores indicating mild osteopenia at their first assessment made the transition to osteoporosis, with an estimated testing interval of about 15 years for 10 percent of women in each of these groups to make the transition.”
While baseline T-score was the most important determining factor for the testing interval, the researchers also found two other significant factors: age and estrogen use. The estimated time to osteoporosis decreased with age, and the authors suggested a screening interval of three years, rather than five, might be beneficial for women aged 85 or older with moderate osteopenia. As for estrogen use, it was significantly associated with higher BMD and longer testing intervals, but the authors cautioned against adjusting the screening interval on the basis of estrogen use due to the short-lived effect of the hormone therapy.
Gourlay et al said the study echoed others suggesting frequent BMD testing is unlikely to improve fracture prediction.
“Recent controversy over the harms of excessive screening for other chronic diseases reinforces the importance of developing a rational screening program for osteoporosis that is based on the best available evidence rather than on healthcare marketing, advocacy and public beliefs that have encouraged overtesting and overtreatment in the U.S.,” wrote the authors.
BMD screening using dual-energy x-ray absorptiometry is recommended for women aged 65 and older. However, no prior guidelines specified an appropriate testing interval, according to Margaret L. Gourlay, MD, of the University of North Carolina in Chapel Hill, and colleagues. The authors noted that the U.S. Preventive Services Task Force suggested that screening intervals as short as two years may be necessary, yet no U.S. study had specifically addressed the issue.
The researchers defined the testing interval as the estimated time during which osteoporosis developed in 10 percent of women before they had a hip or clinical vertebral fracture and before they were treated for osteoporosis. Data came from a 15-year longitudinal study of 4,957 women, aged 67 or older, without osteoporosis at baseline.
Results showed that the estimated BMD testing interval for women with normal BMD (T score of -1 or higher) was 16.8 years. In women with osteopenia (T score of -1.01 to -2.49), BMD testing intervals were shorter: 4.7 years for women with moderate osteopenia and 1.1 years for women with advanced osteopenia.
“Our results suggest that the baseline T score is the most important determinant of a BMD testing interval,” wrote the authors. “During the 15-year study period, less than 1 percent of women with T scores indicating normal BMD and 5 percent of women with T scores indicating mild osteopenia at their first assessment made the transition to osteoporosis, with an estimated testing interval of about 15 years for 10 percent of women in each of these groups to make the transition.”
While baseline T-score was the most important determining factor for the testing interval, the researchers also found two other significant factors: age and estrogen use. The estimated time to osteoporosis decreased with age, and the authors suggested a screening interval of three years, rather than five, might be beneficial for women aged 85 or older with moderate osteopenia. As for estrogen use, it was significantly associated with higher BMD and longer testing intervals, but the authors cautioned against adjusting the screening interval on the basis of estrogen use due to the short-lived effect of the hormone therapy.
Gourlay et al said the study echoed others suggesting frequent BMD testing is unlikely to improve fracture prediction.
“Recent controversy over the harms of excessive screening for other chronic diseases reinforces the importance of developing a rational screening program for osteoporosis that is based on the best available evidence rather than on healthcare marketing, advocacy and public beliefs that have encouraged overtesting and overtreatment in the U.S.,” wrote the authors.
Evan Godt, Writer
Evan joined TriMed in 2011, writing primarily for Health Imaging. Prior to diving into medical journalism, Evan worked for the Nine Network of Public Media in St. Louis. He also has worked in public relations and education. Evan studied journalism at the University of Missouri, with an emphasis on broadcast media.