Should I be screened for osteoporosis?

Aging Health & Wellness

Osteoporosis is a condition of reduced bone density that increases risk of fracture. Women over age 65 and those over age 50 with additional risk factors should be screened with a DEXA scan. Repeat screening intervals depend on the baseline bone density and can range from 1 to 15 years between tests.

What is osteoporosis?

Osteoporosis is a condition that causes reduced bone strength, also called bone density. This “thinning” of the bones makes it easier for bones to break. It can affect any bone in the body but is a big problem for lower back, hip, and upper thigh bones. Breaks in these bones cause significant pain and health complications, including a reduced life expectancy for some older adults.

Who is at risk?

Osteoporosis can occur in people of any gender, age, or ethnic background. However, the largest group at risk is post-menopausal women, as loss of estrogen is likely related to reduction in bone density. Other factors that can increase risk of bone density loss depend on health habits like smoking and drinking alcohol, chronic medical conditions, use of medications that might impair bone health, and family history.

Who should be screened?

Osteoporosis has no symptoms at all, until a broken bone occurs, so understanding who needs screening and treatment to reduce the risk of fracture is very important. Guidelines for who should be screened vary slightly by organization. However, there IS general consensus that screening should be done in these groups:

➡️  Women older than age 65

➡️  Women older than 50 with an additional risk factor, such as:
Low body weight
Heavy alcohol use
Prior fracture
Parent who had a hip fracture

➡️ People chronically taking medications that can harm bone health, like steroids

There is less agreement about whether men should be screened. Some professional groups, such as the Endocrine Society, do recommend screening for all men over 70. Others, such as the U.S. Preventive Services Task Force, find insufficient evidence to make a recommendation.

How do we screen?

The most commonly used test to diagnose osteoporosis is a kind of x-ray of the hip and lower back called a dual-energy x-ray absorptiometry scan, or DEXA scan.

A DEXA scan measures bone density and helps assess the risk of fractures. The x-ray measurements are used to calculate a number called a T score. A T score of zero is the baseline value for a healthy, young person with strong bones. As bones become less dense, the T score reduces and is reported as a negative number. A T score of -1 to -2.4 means the bones are thinner than expected but not thin enough to be labeled as osteoporosis. This condition is called osteopenia. If the T score is lower than -2.5, this indicates a diagnosis of osteoporosis. The lower the T score, the thinner the bones and the risk for a fracture increases.

A FRAX score, or Fracture Risk Assessment Tool, is also used to estimate the risk of broken bones. A FRAX score uses risk factors including age, sex, body measurements, history of broken bones, habits such as tobacco and alcohol use, history of a parent breaking a hip, certain chronic health conditions and the T score from the DEXA scan to estimate the risk of a serious fracture in the next 10 years.

The DEXA scan, FRAX score, and other tests can help clinicians decide who should consider treatment to reduce their risk of fracture.

How often should someone be retested for osteoporosis?

If a person is diagnosed with osteoporosis and receiving treatment, their health care team will make recommendations on how often to repeat a DEXA scan.

But for people with normal bone density or osteopenia, how often should we retest?
Some organizations recommend repeating screening every 2 years after the first DEXA scan.

However, there is some evidence suggesting longer intervals are ok based on severity of bone density reduction on the first DEXA:

✳️ For postmenopausal women with normal bone density or mild osteopenia, a screening interval of 15 years is reasonable
✳️ For postmenopausal women with moderate osteopenia – screening every 5 years
✳️ For postmenopausal women with severe osteopenia – screening in 1 year

This may not apply to women over age 80, however as they seem to lose bone density at an increased rate, so more frequent screening might be appropriate. Talk to your healthcare team about what screening interval makes sense for you.

What should I do to protect my bone density? You can make good choices to protect bone health at any age. Don’t wait until osteoporosis develops to get into bone healthy habits. The following activities can make a big difference:

✅  No smoking, and consider quitting if you do smoke – some useful tips here from Those Nerdy Girls’ archives!
✅  Limit alcohol use
✅  Get enough calcium and vitamin D -a good starting point is 1200 mg of calcium and at least 800 IU of vitamin D through diet and supplements
✅  Get regular exercise 2-3 times weekly that includes both weight-bearing aerobic activity like walking and exercise to build muscle strength like lifting light free weights to support the bones and joints

Stay safe, and stay strong!

Those Nerdy Girls

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