Osteoporosis is a growing concern for Americans. According to the National Osteoporosis Foundation, 10 million Americans have this disease and 34 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 factures as well as a reduced ability to recover from such injuries. Fracturing the hip, spine, or wrist often starts a depressing and socially isolating downward spiral of pain, disability, and deformity for an older person. Being immobilized in this way often means losing independence and the need for 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. Finding out if your bones have become dangerously porous 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
- 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
- Low intake of 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) recommends:
- Bone mineral density screening for all women beginning at age 65.
- Postmenopausal women younger than 65 should only 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.
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, based on risk factors.
- Men age 70 and older as well as those age 50 to 69 with risk factors.
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
Surgeon General's Perspectives. Bone Health: Preventing Osteoporosis. Public Health Reports, Volume 125. May/June 2010. Available online at http://www.publichealthreports.org/issueopen.cfm?articleID=2397 through http://www.publichealthreports.org. Accessed September 2012.
National Osteoporosis Foundation. Why Bone Health is Important. Available online at http://www.nof.org/aboutosteoporosis/bonebasics/whybonehealth through http://www.nof.org. Accessed September 2012.
National Osteoporosis Foundation on Bone Mineral Density Testing. Available online at http://www.nof.org/node/501 through http://www.nof.org. Accessed September 2012.
NIAMS. Osteoporosis and Related Bone Diseases. Available online at http://www.niams.nih.gov/Health_Info/Bone/ through http://www.niams.nih.gov. Accessed September 2012.
NIAMS. Fast Facts About Osteoporosis. Available online at http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/osteoporosis_ff.asp through http://www.niams.nih.gov. Accessed September 2012.
USPSTF. Screening for Osteoporosis. Release Date: January 2011. Available online at http://www.uspreventiveservicestaskforce.org/uspstf/uspsoste.htm through http://www.uspreventiveservicestaskforce.org. Accessed September 2012.
ACOG. Osteoporosis Guidelines Issued. Bone Health Counseling Begins in Adolescence. August 21, 2012. Available online at http://www.acog.org/About_ACOG/News_Room/News_Releases/2012/Osteoporosis_Guidelines_Issued through http://www.acog.org. Accessed September 2012.
Watts, NB et al. Osteoporosis in Men: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology & Metabolism vol. 97 no. 6 1802-1822; June 1, 2012. Available online at http://jcem.endojournals.org/content/97/6/1802.abstract through http://jcem.endojournals.org. Accessed September 2012.
Qaseem A et al. Screening for osteoporosis in men: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2008 May 6;148(9):680-4. Available online at http://www.guidelines.gov/content.aspx?id=12578 through http://www.guidelines.gov. Accessed September 2012.