BMD screening in older women: Initial measurement and testing interval

Abstract

Screening is the early diagnosis of presymptomatic disease among well individuals in the general population.(1) The purpose of osteoporosis screening using bone mineral density (BMD) testing by dual energy X-ray absorptiometry (DXA) is to identify a presymptomatic condition (osteoporosis as defined by World Health Organization diagnostic criteria) that can be treated to prevent an adverse clinical outcome (fragility fractures). An osteoporosis screening program primarily targets the prevention of hip and clinical vertebral fractures because these fractures are associated with the majority of morbidity and health care utilization attributable to osteoporotic fractures. The U.S. Preventive Services Task Force(2) (USPSTF) assigned osteoporosis screening an evidence grade B based on findings from prospective cohort studies of DXA testing and results of randomized controlled trials (RCTs) demonstrating that pharmacologic therapy in postmenopausal women with osteoporosis(3–6) reduced the incidence of fractures. Until recently, prospective data regarding an osteoporosis screening interval were lacking,(7) and several organizations(8–13) recommended BMD screening intervals of about 2 to 5 years based on expert opinion.