Osteoporosis is a systemic skeletal disease that affects over 20 million people in the United States. It is characterized by decreased bone strength and an increase in bone fragility and susceptibility to fracture. The United States Department of Health and Human Services estimates there are 1.5 million fractures, 800,000 emergency room visits, and almost 200,000 nursing home admissions each year from osteoporosis. With these incredible numbers, it is important to identify who is at highest risk for the osteoporosis and to institute preventative treatment as early as possible.
Most of the current focus in osteoporosis screening is on postmenopausal females. Once the preventative effects of estrogen taper off after menopause, women lose bone at an accelerated rate. The loss of absolute bone, as well as the rapidity of bone loss from the matrix, both contribute to a compromised skeletal structure. When should women be screened?
A number of influential medical groups have come out with various guidelines for screening. They include The American Association of Clinical Endocrinologists (AACE), US Preventative Task Force, National Osteoporosis Foundation, and the Osteoporosis Task Force. The general agreement is that all women aged 65 and older and younger menopausal women with risk factors should be screened at least once, and then as needed depending on the results and subsequent treatment. The testing that is done is called a bone densitometry study. There are several devices that are used to scan for osteoporosis, but the one considered the “gold standard” for osteoporosis diagnosis is called a dual-energy x-ray absorptiometry, or DXA.
DXA is reported generally not in absolute values but in comparison to a normal control of the same age. A T-score, which represents how far the measurement is from the age-matched control, is then reported. Osteoporosis is defined as a value of -2.5 (or below) in standard deviations from the mean. The spine, the hip, and the femur are the usual places these results are reported from.
How about men and pre-menopausal women? Men are suggested to have this scanning at least once after age 70. Pre-menopausal women are scanned when they have fractures resulting from mechanical forces that do not ordinarily cause fracture (called fragility fractures), those with a history of eating disorders, those taking medications known to cause osteoporosis, and those who have osteoporosis as a secondary component (such as gastrointestinal disease, connective tissue disorders, and diabetes).
Currently, many premenopausal women are getting DXA scans as part of routine screening when nearing menopause, or just as part of a physical examination. While not necessarily indicated, it sometimes provides a baseline level for people to evaluate their bone health. Since the major pace of osteoporosis however does not appear to accelerate until later in life, the utility of these scans at early ages is limited to those who show marked abnormalities.
Catching osteoporosis earlier in the process is important, as once bone loss has occurred there is little to do except to attempt to arrest the process. Supplementation with calcium and vitamin D is important; children and young adults should receive 1000 mg of calcium daily and in those with osteoporosis, the amounts needed are between 1500 and 2000 mg of calcium and 400-800 IU of Vitamin D. Once osteoporosis is diagnosed, it is important to consult with and follow the recommendations of your doctor. Most advanced medications are available to fight bone resorption and loss, and are available with prescription.
General population based screening in men and premenopausal screening still is not supported by most health agencies and doctors unless there are specific reasons or risk factors. However, older men and postmenopausal women and those at high risk for bone loss should be scanned so that treatment may be started before irreversible changes have taken place.
The information contained on this page is not intended to provide medical advice, which should be obtained directly from your physician.