Reader's Question: I am a 51 year old white female. My mother broke her hip in her 60's and I am concerned for my bones. My doctor told me that I shouldn't be tested until I am 65. Is this correct?
The National Osteoporosis Foundation (NOF) recently published its guidelines on prevention and treatment of osteoporosis. In it, they updated their previously published guidelines for who should be tested. Some of the indications are unchanged from prior guidelines, but there area few additional groups, such as men, that have been added.
Indications for Bone Mineral Density (DXA) testing
- Women age 65 and older and men age 70 and older, regardless of clinical risk factors
- Younger postmenopausal women and men age 50-70 about whom you have concern based on their clinical risk factor profile
- Women in the menopausal transition if there is a specific risk factor associated with increased fracture risk such as low body weight, prior low-trauma fracture, or high risk medication
- Adults who have a fracture after age 50
- Adults with a condition or taking a medication associated with low bone mass or bone loss
- Anyone being considered for pharmacologic therapy for osteoporosis
- Anyone being treated for osteoporosis, to monitor treatment effect
- Anyone not receiving therapy in whom evidence of bone loss would lead to treatment
- Postmenopausal women discontinuing estrogen should be considered for bone density testing.
Young females who are beginning to have irregular periods in their late 40s or 50s or recently postmenopausal females should be tested if there are any specific risk factors that put them at risk. There is an extensive list of conditions mentioned in the NOF guide that one can have. Specific ones that have been included in the WHO Fracture Risk Assessment Model (FRAX, see last month's blog) include:
- History of fracture
- Low body mass index (BMI)
- Use of steroids
- History of Rheumatoid Arthritis
- Parental history of hip fracture
- Current smoking
- Intake of 3 or more drinks of alcohol daily.
The addition of men to the guidelines is also one of the important changes. Unfortunately, osteoporosis has been considered only a "woman's disease" for too long. It is clear that men too can suffer devastating, life altering fractures, although for numerous reasons, 10 years after females. Hopefully, with the publication of these guidelines, the government will begin to pay for screening in males, as it currently does for females.
Clearly, the questioner would fall into one of these categories for testing. With her family history of a hip fracture, she may be at high risk as well and should be evaluated as soon as possible.
 NOF 2008