The U.S. Preventive Services Task Force (USPSTF) is a panel of experts appointed by the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality to review current medical practices and issue recommendations based on their findings. But their recommendations regarding osteoporosis screenings have been a subject of controversy for many years.
“Osteoporosis is a condition that causes a decrease in bone strength and increased fracture risk. Those at high risk for fracture can be identified by low bone density. Osteoporosis is extremely common in older adults, and the statistics show that nearly one in two women will suffer an osteoporosis-related fracture in her lifetime,” says Richard Bockman, MD, PhD, professor of medicine at Weill Cornell Medical College.
A study that appeared in the February 2014 issue of the Journal of Bone and Mineral Research found that following USPSTF recommendations for osteoporosis screening would miss 66 percent of women between ages 50 and 64 who have the disease.
“The USPSTF recommends screening for osteoporosis in women aged 65 years or older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors,” says Dr. Bockman. “A primary consideration for the USPSTF is to con-tain cost. Screening is about the decision of when to measure bone mineral density (BMD) by using adual ener-gy X-ray absorptiometry (DXA) scan, a procedure with a modest cost.”
The standard approach for assessing fracture risk is measuring bone density by DXA. Areas frequently scanned are the spine, hip and wrist, since these are the areas most likely to be affected by osteoporosis, and a measure at the site is the best risk predictor for that site.
“The dilemma is, how does one properly assess risk without making the measurement?” says Dr. Bockman. “Furthermore, most fractures occur in women who appear relatively healthy. It is in this population that screening is most useful for prevention. Elderly, frail women who have suffered a low-trauma fracture do not require screening; they require treatment.”
Recommendations versus reality
According to Dr. Bockman, currently, less than one-third of patients with osteoporosis are diagnosed, and only one-seventh of women in the U.S. with osteoporosis receive treatment. “Any type of screening would improve detection, and, hopefully, prevention,” he says. “With these statistics, a proposal for detection and prevention should be expansive and not restrictive.”
Risk factors for osteoporosis include:
- Female gender
- A body mass index (BMI) of
less than 21
- A history of fracture in either parent
- Daily alcohol use greater than two drinks
- Current tobacco use.
Your physician can enter your data into the Fracture Risk Assessment (FRAX) tool, which estimates 10-year risks for fractures, and decide if you should have a DXA scan. Your doctor also may advise that you be screened if you have an overactive thyroid or a gastrointestinal condition that impedes calcium absorption. Some medications, including corticosteroids, also may weaken your bones because they impede the action of bone-building cells.
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