Osteoporosis is a common disease that is characterized by low bone mass with microarchitectural disruption and bony fragility, resulting in an increased risk of fracture. The goal of screening is to identify high-risk individuals for lifestyle modification and pharmacologic intervention to prevent the first fracture. Some estimates predict a continued rise in the number of hip fractures over the next 3-4 decades. Most fractures occur in women and men without osteoporosis by standard techniques. Osteopenia is the state in which there are far more people and they have a better bone mass than osteoporotic individuals, yet have more fractures. Validated risk factors are:
- Advanced age
- Previous fracture
- Low body weight ( less than 127 lbs )
- Long-term steroid therapy
- Family history of hip fracture
- Cigarette smoking
- Excess alcohol intake
It is recommended that these risk factors should be evaluated in all adults from a routine history and physical examination. Postmenopausal women, men over 60 and any individual who experiences a non traumatic or low impact fracture should be assessed for osteoporotic fractures.
The present recommendations are to obtain Bone Mineral Density test ( DXA ) in all women above 65 years of age and older and postmenopausal women less than 65 years of age with risk factors. In conjunction with osteoporosis screening, individuals require counseling about lifestyle modifications and possible pharmacologic intervention.
The following are standard guidelines for risk reduction counseling:
- Smoking cessation
- Limit alcohol intake
- Regular weight-bearing exercises
- Intake of supplemental calcium of 1200-1500 mg per day
- Vitamin D supplementation of 400-800 int. units per day. Higher doses have been advised in people at risk of deficient Vitamin D in their blood.
- Pharmacologic intervention is appropriate based upon bone mineral density test results and risk factors assessment.
- The frequency of BMD testing is typically every 2 years in women at risk or who are being treated with medications. Those without any risk factors for accelerated bone loss may get a BMD every 3-5 years. Typically all men are not routinely tested with a BMD except in cases where risk factors are present. All premenopausal women should also not be screened for osteoporosis as they are at low risk. The BMD testing is the gold standard for screening for osteoporosis and the best screening sites are the hip and the spine.
If you are at risk based upon the above article please discuss your best options with your primary care physician.