Osteoporosis is a growing concern for Americans. According to the National Osteoporosis Foundation, 10 million Americans have this disease and 43 million are at risk. It is also estimated that half of all women over age 50 will break a bone because of osteoporosis and so will 1 in 4 men.
With aging comes an increased risk of fractures as well as a reduced ability to recover from such injuries. Fracturing the hip, spine, or wrist can cause pain, disability, and deformity for an older person. Being immobilized in this way often means losing independence and needing long-term care.
Because osteoporosis often is "silent" until a fracture occurs, you may not notice you have this disease or realize you are at risk. Getting screened for low bone mass and osteoporosis and treating the problem can help reduce your risk of a fracture.
The following factors increase a person's risk of bone loss and osteoporosis:
- Being female (of those with osteoporosis, 80% are women)
- Older age
- Small, thin body size
- Being white or Asian in ethnicity
- Having a family history of osteoporosis or broken bones
- Having low levels of sex hormones (estrogen in women, testosterone in men), such as during menopause in women
- Having anorexia nervosa
- Deficiencies in calcium and vitamin D
- Lack of exercise
- Smoking cigarettes and drinking alcohol
- Use of certain medications
The bone mineral density (BMD) test is the primary test used to identify osteoporosis and low bone mass. One of the preferred and most accurate ways to measure BMD is Dexa-Scan (dual-energy X-ray absorptiometry or DXA). It uses a low energy X-ray to evaluate bone density in the hip and/or spine.
A number of organizations have published screening guidelines for osteoporosis.
The American College of Obstetricians and Gynecologists (ACOG) has guidelines for women and recommends:
- Bone mineral density screening for all women beginning at age 65.
- Postmenopausal women younger than 65 can be screened with DXA if they have significant risk factors for osteoporosis and/or bone fracture.
- In the absence of new risk factors, DXA screening should not be performed more frequently than every two years.
- Use of FRAX, a fracture risk assessment tool, to further predict someone's risk of bone fracture in the next 10 years; can be done annually to monitor effect of age on fracture risk.
The U.S. Preventive Service Task Force (USPSTF) recommends:
- Osteoporosis screening for women 65 years of age or older and for 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.
- For men, the Task Force says the current evidence is insufficient to assess whether screening for osteoporosis would be beneficial or harmful.
The National Osteoporosis Foundation recommends screening adults with bone mineral density testing as follows:
- Women 65 years of age and older as well as some younger postmenopausal women who have risk factors or who have had a fracture as an adult.
- Men age 70 and older as well as those age 50 to 69 who have risk factors or have had a fracture as an adult.
Osteoporosis screening guidelines for men published in May 2008 by the American College of Physicians point out that this condition is underdiagnosed in men.
- The guidelines recommend periodic risk assessment for osteoporosis in older men and DXA for men who are at increased risk and are candidates for drug therapy.
The Endocrine Society issued guidelines in 2012 for managing osteoporosis in men that recommend:
- Men at high risk for osteoporosis (e.g., those aged 70 and older; those aged 50-69 with risk factors like low body weight, smoking, and previous fracture) should be screened with DXA.
Sources Used in Current Review
ACOG. Osteoporosis Guidelines Issued. Bone Health Counseling Begins in Adolescence. August 21, 2012. Available online at https://www.guideline.gov/content.aspx?id=38413. Accessed June 2016.
Watts NB, Adler RA, Bilezikian JP, Drake MT, Eastell R, Orwoll ES, Finkelstein JS. Osteoporosis in men: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012 Jun;97(6):1802-22. Available online at https://www.guideline.gov/content.aspx?id=37827&search=osteoporosis. Accessed June 2016.
Cosman F, et al. Clinician's Guide to Prevention and Treatment of Osteoporosis. National Osteoporosis Foundation. Available online at http://link.springer.com/article/10.1007/s00198-014-2794-2. Accessed June 2016.
(January 2011) The U.S. Preventive Service Task Force. Osteoporosis: Screening. Available online at http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/osteoporosis-screening. Accessed June 2016.
Screening for Osteoporosis in Men: Recommendations from the American College of Physicians. Ann Intern Med. 2008;148:I-35. Available online at http://annals.org/article.aspx?articleid=740939. Accessed June 2016.