New Screening Guidelines: Less Frequent = Just as Effective?

PJ Hamel Health Guide
  • If you’re a woman aged 65 or older, generally accepted recommendations for osteoporosis screening call for it to begin at age 65, and continue every 2 years thereafter.

    But that may be about to change.

    The current U.S. Preventive Services Task Force recommendations, developed in 2002, are being challenged by findings of a study released at the annual meeting of the American Society for Bone Mineral Research, held in Toronto in October.

    At that meeting, Margaret L. Gourlay, MD, MPH, of the University of North Carolina at Chapel Hill School of Medicine, offered evidence that women aged 67 and older, with fairly good bone density, may not need to be screened again for 10 years – rather than every other year.

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    Findings were based on evidence gathered in the Study of Osteoporotic Fractures, the longest-running osteoporosis study in the U.S.

    Gourlay, co-author of the study, notes that there has never been any definitive evidence, one way or another, on age/screening intervals for osteoporosis. Gourlay and her fellow researchers attempted in their study to provide hard data that could be used to determine such guidelines.

    Here’s what they found.

    For women with baseline T-scores ranging from -2.49 to -2.00 – just below the threshold for a diagnosis of osteoporosis – it took about 15 months for those scores to fall into osteoporosis range. Thus, it makes sense for these women to be screened every 2 years.

    For women whose T-scores ranged from -1.99 to -1.50 – considered at moderate risk for osteoporosis – the estimated time until the scores transitioned to osteoporosis was about 5 years.

    Should these women be screened every other year? Not necessarily; underlying risk factors might make such screening advisable, but it’s not a given for everyone.

    Women with T-scores of -1.49 to -1.01 (considered low risk) didn’t develop osteoporosis for about 16 years. Clearly, these women don’t need to be screened every 2 years – unless, as noted above, they carry other risk factors that would make such screening necessary.

    If you’re over age 65, you’ve probably had your first baseline screening – a DEXA scan. Do you know what your numbers were? If not, go back and check them. If they’re better than -1.99, you can probably extend the interval until your next DEXA out a few years.

    If they’re better than -1.49, then you can stretch the time even longer. Gourlay and her group recommend 10 years, to be safe.

    Remember, this presupposes no other underlying health factors that might increase your risk, including body type and family history; lifestyle-induced risks; use of certain drugs; and a previous osteoporosis-related fracture.

    But if you’ve got a clean slate, health-wise, consider putting off that next DEXA. The fewer unnecessary tests you get, the better – for you, AND your pocketbook.

Published On: January 22, 2011