Osteoporosis screening: Difference between revisions
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=== Risk assessment === | === Risk assessment === | ||
Today, risk of fracture due to osteoporosis is threatening one out of two postmenopausal women and also one out of five older men. Leading ethnicity involved in osteoporosis is white. The rate of osteoporosis is higher in elderly. The 10-year risk for any osteoporosis-related fractures in 65-year-old white woman with no other risk factor is 9.3%. The 10-year probability of hip fracture can be estimated by the [http://www.shef.ac.uk/FRAX/ FRAX tool] based on the presence or absence of clinical risk factors in addition to the bone mineral density (BMD) at the femoral neck. | * Today, risk of fracture due to osteoporosis is threatening one out of two postmenopausal women and also one out of five older men. Leading ethnicity involved in osteoporosis is white. The rate of osteoporosis is higher in elderly. The 10-year risk for any osteoporosis-related fractures in 65-year-old white woman with no other risk factor is 9.3%. The 10-year probability of hip fracture can be estimated by the [http://www.shef.ac.uk/FRAX/ FRAX tool] based on the presence or absence of clinical risk factors in addition to the bone mineral density (BMD) at the femoral neck. | ||
=== Screening criteria === | === Screening criteria === | ||
The US Preventive Services Task Force (USPSTF) divides the population to three groups, categorize their need to be screened for osteoporosis; they include: | * The US Preventive Services Task Force (USPSTF) divides the population to three groups, categorize their need to be screened for osteoporosis; they include: | ||
# Women of 65 years and older, without any fracture history or pathological reason for osteoporosis | # Women of 65 years and older, without any fracture history or pathological reason for osteoporosis | ||
# Women of less than 65 years, with 10-year fracture risk of not less than a 65-year-old white woman (who has not any other risk factor) | # Women of less than 65 years, with 10-year fracture risk of not less than a 65-year-old white woman (who has not any other risk factor) | ||
# Men with no osteoporosis history | # Men with no osteoporosis history | ||
Upon the guidelines of USPSTF, the former two groups (women) are target of screening for osteoporosis; but there is not any recommendation to screen the third group (men) for the disease.<ref name="pmid21242341">{{cite journal| author=U.S. Preventive Services Task Force| title=Screening for osteoporosis: U.S. preventive services task force recommendation statement. | journal=Ann Intern Med | year= 2011 | volume= 154 | issue= 5 | pages= 356-64 | pmid=21242341 | doi=10.7326/0003-4819-154-5-201103010-00307 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21242341 }} </ref> | * Upon the guidelines of USPSTF, the former two groups (women) are target of screening for osteoporosis; but there is not any recommendation to screen the third group (men) for the disease.<ref name="pmid21242341">{{cite journal| author=U.S. Preventive Services Task Force| title=Screening for osteoporosis: U.S. preventive services task force recommendation statement. | journal=Ann Intern Med | year= 2011 | volume= 154 | issue= 5 | pages= 356-64 | pmid=21242341 | doi=10.7326/0003-4819-154-5-201103010-00307 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21242341 }} </ref> | ||
Prior USPSTF recommendations from 2002 were include: | * Prior USPSTF recommendations from 2002 were include: | ||
* All women of 65 and older should be screened by bone marrow densitometry.<ref name="pmid12230355">{{cite journal |author=U.S. Preventive Services Task Force |title=Screening for osteoporosis in postmenopausal women: recommendations and rationale |journal=Ann. Intern. Med. |volume=137 |issue=6 |pages=526-8|year=2002 |pmid=12230355 |doi=}}</ref> | ** All women of 65 and older should be screened by bone marrow densitometry.<ref name="pmid12230355">{{cite journal |author=U.S. Preventive Services Task Force |title=Screening for osteoporosis in postmenopausal women: recommendations and rationale |journal=Ann. Intern. Med. |volume=137 |issue=6 |pages=526-8|year=2002 |pmid=12230355 |doi=}}</ref> | ||
* The USPSTF recommends screening women aged 60-64 years old, who are at increased risk of fracture. The most significant risk factor for indicating an increased probability of having osteoporosis is lower body weight (< 70 kg). | ** The USPSTF recommends screening women aged 60-64 years old, who are at increased risk of fracture. The most significant risk factor for indicating an increased probability of having osteoporosis is lower body weight (< 70 kg). | ||
* Clinical prediction rules are available to guide selection of women for screening. The [http://osteoed.org/tools.php?type=orai Osteoporosis Risk Assessment Instrument (ORAI)] may be the most [[sensitivity (tests)|sensitive]] strategy.<ref name="pmid17552058">{{cite journal |author=Martínez-Aguilà D, Gómez-Vaquero C, Rozadilla A, Romera M, Narváez J, Nolla JM |title=Decision rules for selecting women for bone mineral density testing: application in postmenopausal women referred to a bone densitometry unit |journal=J. Rheumatol. |volume=34 |issue=6|pages=1307-12 |year=2007 |pmid=17552058 |doi=}}</ref> | ** Clinical prediction rules are available to guide selection of women for screening. The [http://osteoed.org/tools.php?type=orai Osteoporosis Risk Assessment Instrument (ORAI)] may be the most [[sensitivity (tests)|sensitive]] strategy.<ref name="pmid17552058">{{cite journal |author=Martínez-Aguilà D, Gómez-Vaquero C, Rozadilla A, Romera M, Narváez J, Nolla JM |title=Decision rules for selecting women for bone mineral density testing: application in postmenopausal women referred to a bone densitometry unit |journal=J. Rheumatol. |volume=34 |issue=6|pages=1307-12 |year=2007 |pmid=17552058 |doi=}}</ref> | ||
* Regarding the screening process for men, a cost-analysis study suggests that screening may be "cost-effective for men with a self-reported prior fracture beginning at age 65 years, and for men 80 years and older with no prior fracture".<ref name="pmid17684185">{{cite journal |author=Schousboe JT, Taylor BC, Fink HA, ''et al'' |title=Cost-effectiveness of bone densitometry followed by treatment of osteoporosis in older men |journal=JAMA |volume=298 |issue=6 |pages=629-37 |year=2007 |pmid=17684185|doi=10.1001/jama.298.6.629}}</ref> | ** Regarding the screening process for men, a cost-analysis study suggests that screening may be "cost-effective for men with a self-reported prior fracture beginning at age 65 years, and for men 80 years and older with no prior fracture".<ref name="pmid17684185">{{cite journal |author=Schousboe JT, Taylor BC, Fink HA, ''et al'' |title=Cost-effectiveness of bone densitometry followed by treatment of osteoporosis in older men |journal=JAMA |volume=298 |issue=6 |pages=629-37 |year=2007 |pmid=17684185|doi=10.1001/jama.298.6.629}}</ref> | ||
=== Screening tool === | === Screening tool === | ||
There are two major methods, that is suggested to use for screening osteoporosis; they include: | * There are two major methods, that is suggested to use for screening osteoporosis; they include: | ||
# Dual energy x-ray absorptiometry (DXA) of both hip and lumbar spine bones | # Dual energy x-ray absorptiometry (DXA) of both hip and lumbar spine bones | ||
# Quantitative ultrasonography of the calcaneus | # Quantitative ultrasonography of the calcaneus | ||
Although quantitative ultrasonography has lower price, more portability, lower ionizing radiation exposure for patients, and otherwise the same power of fracture prediction (in femoral neck, hip, and spine) comparing with DXA method, current diagnostic and treatment criteria rely on DXA of the hip and lumbar spine. | * Although quantitative ultrasonography has lower price, more portability, lower ionizing radiation exposure for patients, and otherwise the same power of fracture prediction (in femoral neck, hip, and spine) comparing with DXA method, current diagnostic and treatment criteria rely on DXA of the hip and lumbar spine. | ||
=== Screening protocol === | === Screening protocol === | ||
After an initial screening [[bone mineral density]] (BMD), optimal intervals to repeat the test may include the followings: | * After an initial screening [[bone mineral density]] (BMD), optimal intervals to repeat the test may include the followings: | ||
* 15 years for women with normal bone density or mild osteopenia: T-score of greater than −1.50 | ** 15 years for women with normal bone density or mild osteopenia: T-score of greater than −1.50 | ||
* 5 years for women with moderate osteopenia: T-score of −1.50 to −1.99 | ** 5 years for women with moderate osteopenia: T-score of −1.50 to −1.99 | ||
* 1 year for women with advanced osteopenia: T-score of −2.00 to −2.49 <ref name="pmid22256806">{{cite journal |vauthors=Gourlay ML, Fine JP, Preisser JS, May RC, Li C, Lui LY, Ransohoff DF, Cauley JA, Ensrud KE |title=Bone-density testing interval and transition to osteoporosis in older women |journal=N. Engl. J. Med. |volume=366 |issue=3 |pages=225–33 |year=2012 |pmid=22256806 |pmc=3285114 |doi=10.1056/NEJMoa1107142 |url=}}</ref> | ** 1 year for women with advanced osteopenia: T-score of −2.00 to −2.49 <ref name="pmid22256806">{{cite journal |vauthors=Gourlay ML, Fine JP, Preisser JS, May RC, Li C, Lui LY, Ransohoff DF, Cauley JA, Ensrud KE |title=Bone-density testing interval and transition to osteoporosis in older women |journal=N. Engl. J. Med. |volume=366 |issue=3 |pages=225–33 |year=2012 |pmid=22256806 |pmc=3285114 |doi=10.1056/NEJMoa1107142 |url=}}</ref> | ||
=== Osteoporosis Screening Recommendations of Other Organizations === | |||
{| class="wikitable" | {| class="wikitable" | ||
| Line 48: | Line 49: | ||
|- | |- | ||
! National Osteoporosis Foundation | ! National Osteoporosis Foundation (NOF) <ref name="pmid25182228">{{cite journal| author=Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S et al.| title=Clinician's Guide to Prevention and Treatment of Osteoporosis. | journal=Osteoporos Int | year= 2014 | volume= 25 | issue= 10 | pages= 2359-81 | pmid=25182228 | doi=10.1007/s00198-014-2794-2 | pmc=4176573 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25182228 }}</ref> | ||
| BMD testing for | | BMD testing for: | ||
* All ≥ 65 years old | |||
* Postmenopausal <65 years old, based on risk factor profile | |||
| BMD testing for | | BMD testing for: | ||
* All men ≥70 years old | |||
* Men aged 50-69 years old, based on risk factor profile | |||
|- | |- | ||
! World Health Organization | ! World Health Organization (WHO) <ref name="urlwww.euro.who.int">{{cite web |url=http://www.euro.who.int/document/e88668.pdf |title=www.euro.who.int |format= |work= |accessdate=}}</ref> | ||
| Indirect | | Indirect records suggest screening women ≥65 years old, while no direct record suggests using BMD testing for holistic screening programs | ||
| - | | - | ||
| Line 64: | Line 69: | ||
|- | |- | ||
! American College of Physicians | ! American College of Physicians <ref name="pmid18458281">{{cite journal |vauthors=Qaseem A, Snow V, Shekelle P, Hopkins R, Forciea MA, Owens DK |title=Screening for osteoporosis in men: a clinical practice guideline from the American College of Physicians |journal=Ann. Intern. Med. |volume=148 |issue=9 |pages=680–4 |year=2008 |pmid=18458281 |doi= |url=}}</ref> | ||
| - | | - | ||
| Clinicians should | | Clinicians should investigate older men for osteoporosis risk factors; use DXA to screen men with increased risk, maybe candidates of drug therapy for osteoporosis | ||
|- | |- | ||
! American Congress of Obstetricians and Gynecologists | ! American Congress of Obstetricians and Gynecologists (ACOG) <ref name="pmid22914492">{{cite journal |vauthors= |title=ACOG Practice Bulletin N. 129. Osteoporosis |journal=Obstet Gynecol |volume=120 |issue=3 |pages=718–34 |year=2012 |pmid=22914492 |doi=10.1097/AOG.0b013e31826dc446 |url=}}</ref> | ||
| BMD testing for | | BMD testing for: | ||
* All ≥65 yearcs old | |||
* Postmenopausal <65 years old, with 1 or more risk factors | |||
| - | | - | ||
Revision as of 16:23, 3 August 2017
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Osteoporosis Microchapters |
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Osteoporosis screening On the Web |
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American Roentgen Ray Society Images of Osteoporosis screening |
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Risk calculators and risk factors for Osteoporosis screening |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2], Raviteja Guddeti, M.B.B.S.[3]
Overview
Osteoporosis is common in people 65 years and older. Bone turnover is unbalanced in elderly individuals, especially in females because of the lack of estrogen after menopause. The US Preventive Services Task Force (USPSTF) recommends that all women 65 and older be screened with a DEXA scan.
Screening
Risk assessment
- Today, risk of fracture due to osteoporosis is threatening one out of two postmenopausal women and also one out of five older men. Leading ethnicity involved in osteoporosis is white. The rate of osteoporosis is higher in elderly. The 10-year risk for any osteoporosis-related fractures in 65-year-old white woman with no other risk factor is 9.3%. The 10-year probability of hip fracture can be estimated by the FRAX tool based on the presence or absence of clinical risk factors in addition to the bone mineral density (BMD) at the femoral neck.
Screening criteria
- The US Preventive Services Task Force (USPSTF) divides the population to three groups, categorize their need to be screened for osteoporosis; they include:
- Women of 65 years and older, without any fracture history or pathological reason for osteoporosis
- Women of less than 65 years, with 10-year fracture risk of not less than a 65-year-old white woman (who has not any other risk factor)
- Men with no osteoporosis history
- Upon the guidelines of USPSTF, the former two groups (women) are target of screening for osteoporosis; but there is not any recommendation to screen the third group (men) for the disease.[1]
- Prior USPSTF recommendations from 2002 were include:
- All women of 65 and older should be screened by bone marrow densitometry.[2]
- The USPSTF recommends screening women aged 60-64 years old, who are at increased risk of fracture. The most significant risk factor for indicating an increased probability of having osteoporosis is lower body weight (< 70 kg).
- Clinical prediction rules are available to guide selection of women for screening. The Osteoporosis Risk Assessment Instrument (ORAI) may be the most sensitive strategy.[3]
- Regarding the screening process for men, a cost-analysis study suggests that screening may be "cost-effective for men with a self-reported prior fracture beginning at age 65 years, and for men 80 years and older with no prior fracture".[4]
Screening tool
- There are two major methods, that is suggested to use for screening osteoporosis; they include:
- Dual energy x-ray absorptiometry (DXA) of both hip and lumbar spine bones
- Quantitative ultrasonography of the calcaneus
- Although quantitative ultrasonography has lower price, more portability, lower ionizing radiation exposure for patients, and otherwise the same power of fracture prediction (in femoral neck, hip, and spine) comparing with DXA method, current diagnostic and treatment criteria rely on DXA of the hip and lumbar spine.
Screening protocol
- After an initial screening bone mineral density (BMD), optimal intervals to repeat the test may include the followings:
- 15 years for women with normal bone density or mild osteopenia: T-score of greater than −1.50
- 5 years for women with moderate osteopenia: T-score of −1.50 to −1.99
- 1 year for women with advanced osteopenia: T-score of −2.00 to −2.49 [5]
Osteoporosis Screening Recommendations of Other Organizations
| Organizations | Women | Men |
|---|---|---|
| National Osteoporosis Foundation (NOF) [6] | BMD testing for:
|
BMD testing for:
|
| World Health Organization (WHO) [7] | Indirect records suggest screening women ≥65 years old, while no direct record suggests using BMD testing for holistic screening programs | - |
| American College of Physicians [8] | - | Clinicians should investigate older men for osteoporosis risk factors; use DXA to screen men with increased risk, maybe candidates of drug therapy for osteoporosis |
| American Congress of Obstetricians and Gynecologists (ACOG) [9] | BMD testing for:
|
- |
References
- ↑ U.S. Preventive Services Task Force (2011). "Screening for osteoporosis: U.S. preventive services task force recommendation statement". Ann Intern Med. 154 (5): 356–64. doi:10.7326/0003-4819-154-5-201103010-00307. PMID 21242341.
- ↑ U.S. Preventive Services Task Force (2002). "Screening for osteoporosis in postmenopausal women: recommendations and rationale". Ann. Intern. Med. 137 (6): 526–8. PMID 12230355.
- ↑ Martínez-Aguilà D, Gómez-Vaquero C, Rozadilla A, Romera M, Narváez J, Nolla JM (2007). "Decision rules for selecting women for bone mineral density testing: application in postmenopausal women referred to a bone densitometry unit". J. Rheumatol. 34 (6): 1307–12. PMID 17552058.
- ↑ Schousboe JT, Taylor BC, Fink HA; et al. (2007). "Cost-effectiveness of bone densitometry followed by treatment of osteoporosis in older men". JAMA. 298 (6): 629–37. doi:10.1001/jama.298.6.629. PMID 17684185.
- ↑ Gourlay ML, Fine JP, Preisser JS, May RC, Li C, Lui LY, Ransohoff DF, Cauley JA, Ensrud KE (2012). "Bone-density testing interval and transition to osteoporosis in older women". N. Engl. J. Med. 366 (3): 225–33. doi:10.1056/NEJMoa1107142. PMC 3285114. PMID 22256806.
- ↑ Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S; et al. (2014). "Clinician's Guide to Prevention and Treatment of Osteoporosis". Osteoporos Int. 25 (10): 2359–81. doi:10.1007/s00198-014-2794-2. PMC 4176573. PMID 25182228.
- ↑ "www.euro.who.int" (PDF).
- ↑ Qaseem A, Snow V, Shekelle P, Hopkins R, Forciea MA, Owens DK (2008). "Screening for osteoporosis in men: a clinical practice guideline from the American College of Physicians". Ann. Intern. Med. 148 (9): 680–4. PMID 18458281.
- ↑ "ACOG Practice Bulletin N. 129. Osteoporosis". Obstet Gynecol. 120 (3): 718–34. 2012. doi:10.1097/AOG.0b013e31826dc446. PMID 22914492.