Approximately 12 million Americans older than 50 years have osteoporosis. One half of all postmenopausal women will have an osteoporosis-related fracture during their lifetime; 25% of these women will develop a vertebral deformity, and 15% will experience a hip fracture.
Osteoporotic fractures, particularly hip fractures, are associated with chronic pain and disability, loss of independence, decreased quality of life, and increased mortality. Although hip fractures are less common in men than in women, more than one-third of men who experience a hip fracture die within one year.
Potential harms of screening for osteoporosis include false-positive test results causing unnecessary treatment, false-negative test results, and patient anxiety about positive test results.
The experts found no new studies that described harms of screening for osteoporosis in men or women. Screening with a bone X-ray machine is associated with opportunity costs (time and effort required by you and the health care system).
Harms of drug therapies for osteoporosis depend on the specific medication used. The experts found adequate evidence that the harms of bisphosphonates, the most commonly prescribed therapies, are no greater than small. Convincing evidence indicates that the harms of estrogen and selective estrogen receptor modulators are small to moderate.
Your MUSC Health doctor or clinical team will ask you questions and complete a survey to assess your risk. You may also be asked to take a bone X-ray to measure the size of your bones and assess your risk for a fracture in the next few years.
One of the most common assessment surveys estimate risk for the next ten years (the FRAX, fracture risk assessment tool). Your personal measurements such as age, body mass index (BMI), history or fractures in your parents, tobacco use, alcohol use may be confirmed by the doctor or nurse.
There is not enough research to understand how often you should be screened for your risk of a osteoporotic bone fracture. Once your risk is assessed it may take a few years for the risk factors to change enough to justify another examination.
The most commonly used bone measurement tests used to screen for osteoporosis are Dual-energy X-ray absorptiometry (DXA, previously DEXA) of the hip and lower back and quantitative ultrasonography of the heel bone. Quantitative ultrasonography is less expensive and more portable than Dual-energy X-ray and does not expose patients to ionizing radiation. Quantitative ultrasonography of the heel bone predicts fractures of the femoral neck, hip, and spine as effectively as Dual-energy X-ray. However, current diagnostic and treatment criteria for osteoporosis rely on Dual-energy X-ray measurements only, and criteria based on quantitative ultrasonography or a combination of quantitative ultrasonography and Dual-energy X-ray have not been defined. The number of individuals needed to be screened to reduce one hip or back fracture is influenced by age. At age 55 to 59 more than 4,300 women are needed, at age 75 to 79 only 145 women screened will reduce one fracture.
What is the FRAX risk assessment?
The FRAX assessment tool is one of the most widely used instruments to predict risk for fractures and was derived from data on 9 different, large, world-wide study groups. The FRAX tool also predicts ten-year fracture risks for black, Asian, and Hispanic women in the United States. In general, estimated fracture risks in nonwhite women are lower than those for white women of the same age.
How is Osteoporosis Treated?
In addition to adequate calcium and vitamin D intake and weight-bearing exercise, multiple drug therapies are used to reduce fractures, including bisphosphonates, parathyroid hormone, raloxifene, and estrogen. The choice of therapy should be based on the patient’s clinical situation and the relative benefits and risks. Doctors should provide patient education on how to use drug therapies to minimize adverse effects.
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