Osteoporosis Screening May Be Needed Less Often Than Previously Believed

Abstract

NEW DATA FILL A GAP IN OSTEOporosis screening recommendations, suggesting that postmenopausal women undergo bone mineral density (BMD) testing yearly, every 5 years, or every 15 years based on their BMD T scores. Thestudy,published inJanuary in the NewEnglandJournalofMedicine, followed up 4957 women aged 67 years or older for 15 years. The participants were part of the Study of Osteoporotic Fractures, which began in 1986 and is the longest runningosteoporosisstudyintheUnited States.Apreviousanalysisfromthisgroup showedthat inhealthy,olderpostmenopausal women, a repeat BMD test performed 8 years after the initial test didn’t providemuchnewinformationinpredicting fracture risk (Hillier TA et al. Arch Intern Med. 2007;167[2]:155-160). Inthenewestanalysis,womenstudied had normal BMD—a T score at the femoral neck and total hip of −1.00 or higher—or osteopenia, which is characterized by a T score between −1.01 and −2.49withnohistoryofhiporclinicalvertebral fracture or treatment for osteoporosis. All had at least 2 BMD tests during the study period; some were tested up to 5 times. To determine how long it would take to find clinically meaningful BMD changes between tests, the investigators calculated the time it would take for 10% of women with normal BMD or mild, moderate, or advanced osteopenia to develop osteoporosis before having a hip or spine fracture. The data were adjusted for estrogen use and clinical risk factors, including age, body mass index, current smoking, oral glucocorticoid use, and rheumatoid arthritis. Resultsshowedthatthetimefromprior BMD examination to development of osteoporosis is about 17 years for women with normal BMD and mild osteopenia, about 5 years for women with moderate osteopenia, and about 1 year for women with advanced osteopenia. Lead author Margaret Gourlay, MD, PhD, an assistant professor of family medicine at theUniversityofNorthCarolinaatChapelHillSchoolofMedicine, said the findings mean that postmenopausal women with the highest BMD wouldn’t need rescreening for about 15 years. “That was longer than we expected, and it’s great news for this group of women,” said Gourlay. Gourlayandhercolleaguesnoted that even though a number of professional groupsrecommendBMDscreeningwith dual-energy x-ray absorptiometry for women aged 65 years and older, none specify screening intervalsbasedon longitudinalcohortstudies.Theresearchers quoteda2011statementfromtheUSPreventive Services Task Force that said, “ . . . aminimumof2yearsmaybeneeded toreliablymeasureachangeinBMD;however, longer intervalsmaybenecessaryto improve fracture risk prediction.” The researchers also pointed to recent debates about potential harm to patients from screening tests for such chronic illnesses as breast and prostate cancers. The utility of prostatespecific antigen testing and the most effective age for women to begin having mammograms have sparked widespread disagreements among health professionals, professional groups, and advocacy organizations. Those controversies, they said, “reinforce the importance of developing a rational screening program for osteoporosis that is based on the best available evidence rather than on health care marketing, advocacy, and public beliefs that have encouraged overtesting and overtreatment in the United States.” news@JAMA From JAMA’s Daily News Site