Who Should have a Bone Mineral Density (BMD) test?

Many patients should be getting screened for osteoporosis…. but are not getting the tests done

Osteoporosis is a systemic bone-resorbing disease that causes bone fragility and a subsequent risk of breakinga bone (i.e having a fracture). Osteoporosis is common. 20 % of women over 50 and 5% of men over 50 have osteoporosis.

There are four key components to osteoporosis: 1) low bone mass 2) microarchitectural deterioration 3) increase in fragility as a result of these and 4) increased susceptibility to fracture.

DEFINITION OF OSTEOPOROSIS

The WHO 1996 definition of osteoporosis includes four key components:

1) low bone mass

2) microarchitectural deterioration

3) increase in fragility as a result of these

4) increased susceptibility to fracture.

RISK FACTORS FOR OSTEOPOROSIS

Risk factors for osteoporosis are divided into two categories: modifiable and non-modifiable.

Modifiable risk factors include: low body weight, smoking, alcohol consumption, lack of exercise, deficiency of dietary calcium, and long-term glucocorticoid use.

The non-modifiable group include: gender, age, race, and genetic characteristics.

TESTING FOR OSTEOPOROSIS WITH BONE DENSITY

Bone Mineral Density (BMD) tests help assess bone density.. These tests are safe, painless and accurately measure the density of bones.

WHO SHOULD GET A BONE MINERAL DENSITY TEST?

It’s critically important to take note of who should have a BMD test. This helps identify patients who may be at increased risk

• All women and men 65 years or older

• Postmenopausal women and men age 50 – 64 with risk factors for fracture including:

  • fragility fracture after age 40

  • Vertebral fracture or low bone mass identified on x-ray

  • hip fracture in a parent

  • patient consumes significant alcohol

  • patient is current smoker

  • Low body weight, i.e. less than 132 lbs or 60 kg

  • Weight loss since age 25 greater than 10%

  • High risk medication use: prolonged glucocorticoid use, aromatase inhibitors for breast cancer, androgen deprivation therapy for prostate cancer

  • Rheumatoid arthritis

  • Other disorders that may contribute to bone loss

• Younger men or women (under age 50) with a disease or condition associated with low bone mass or bone loss:

  • Fragility fractures

  • High-risk medication use (steroid use, aromatase inhibitors, androgen deprivation therapy)

  • Rheumatoid arthritis

  • Other chronic inflammatory conditions

  • Cushing’s disease

  • Malabsorption syndrome

  • Uncontrolled hyperthyroidism

  • Primary hyperparathyroidism

  • Hypogonadism; Early menopause (< 45)

  • Other disorders associated with rapid bone loss/fractures