Periodic Screening Recommendation for Osteoporosis

The clinical recommendations are that every patient over the age of 50 should be assessed. Thus, every patient 65 years of age and older should be regularly screened for risk factors for osteoporosis and fragility fractures. This applies to both females and males.

Screening starts at 65 years with the frequency depending on the intervals based on age, baseline Bone Mineral Density (BMD), and time to transition to osteoporosis. The Frax Screening tool acts as a guide.

Females with normal bone mass or mild bone loss are screened every 4-8 years after initial screening, while those with moderate to severe bone loss are screened every 1-2 years.

Cessation of screening is not recommended as the risk for osteoporosis increases with age.

Screening is a good mechanism and bone measurement findings are accurate for the early prediction of osteoporotic fractures in women and men. This helps in guiding patients on when to begin drug therapies to prevent osteoporotic fractures. Recent statistics have revealed a moderate reduction in the number of hip fractures.

Dual Energy X-ray Absorptiometry (DXA) is the main screening tool. There are two types, which are Central DXA, which measures the lumbar spine and the hip, and Peripheral DXA which assesses the peripheral regions. This screening tool is appropriate as it evaluates the degree of spread of osteoporosis and Bone Mineral Density (BMD) with a great level of accuracy. This helps in planning for and directing patient management to prevent osteoporotic fractures.

Quantitative ultrasound is an appropriate screening, which assesses regions in the periphery. This imaging modality provides precise and reliable findings comparable to peripheral DXA without having to subject patients to radiations, unlike DXA. However, it does not check for Bone Mineral Density.

Plain radiographs can help in suggesting osteopenia but is inappropriate in screening, as they cannot pick up osteoporosis in the early stages.

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