Less found to be best for osteoporosis screening

Women with normal bone density at age 65 can safely wait as long as 15 years before having another bone density scan, researchers report in a study just published in The New England Journal of Medicine.

The finding runs counter to the common practice of testing bone density in older women every two years, which happens to be the screening frequency that Medicare will cover. But medical experts have recently been rethinking how often to screen for and treat osteoporosis, and the latest research suggests that the frequency of screenings, as well as the use of preventive medications, can be scaled back.

The study, authored by a researcher at the University of North Carolina at Chapel Hill and colleagues, followed nearly 5,000 women aged 67 and older for more than a decade. All of the women had a bone density scan upon entering the study, and none had osteoporosis at baseline. Those women whose initial bone density was normal or only slightly low had a very small risk of developing osteoporosis in the ensuing 15 years: Fewer than 1 percent of the former group and fewer than 5 percent of the latter developed the disease during that period. However, of those women whose initial bone density was substantially low, 10 percent developed osteoporosis within about a year.

The study thus sheds light on the significance of a bone density test at age 65 as a predictor of future bone health. As one expert remarked, the results provide evidence that if you have normal bone density in your 60s or early 70s ¦you are not going to have osteoporosis in the next five years unless something else happens. The study findings also suggest that doctors need not prescribe bisphonates, such as Fosamax, as a preventive therapy to women whose bone density is lower than normal but not in a danger zone. (An important exception is women over 50 who have had a fracture of the hip, wrist, or other large bone.)

ACSH s Dr. Gilbert Ross is impressed with the findings. These results show that the risk of developing osteoporosis is very low if you have a normal bone density after age 65, he says. Doctors should adjust screening frequency accordingly.