Osteoporosis: Who Should Be Screened?

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Summary and Comment

Osteoporosis: Who Should Be Screened?

Whom should clinicians screen for osteoporosis? Because many experts have concluded that clinical risk factors do not accurately predict the likelihood of fracture, screening is controversial. Some clinicians screen all of their patients, while others do not, often citing cost as the reason. Some clinicians screen women who are not on hormone therapy (HT), especially if they have risk factors. These authors administered a questionnaire on possible risk factors for osteoporosis to 1610 white menopausal women (mean age, 62 years), followed by a dual-energy X-ray absorptiometry scan of the spine, hip, and femoral neck.

Osteoporosis was present at 1 or more sites in 35.3 percent of the women. Absence of estrogen use, either in the form of oral contraceptives (OC) or HT, was the only dependent variable that significantly predicted osteoporosis. Independent variables that were significant positive predictors of osteoporosis were increasing age, decreasing weight, and years since menopause.

Comment: The authors conclude that many of the accepted risk factors for osteoporosis may not be reliable in determining whom to screen. Using the range of confidence intervals for the presence of osteoporosis at various ages and body weights, the authors recommend that clinicians screen women older than 65 who weighed less than 140 pounds at menopause or who have never used estrogen for 6 months or longer. It should be noted that this study population was not racially diverse. The question of whom to screen for osteoporosis is far from answered; however, with each new study more answers should be available to help clinicians who are consistently faced with this decision.

— AJ Davis

Published in Journal Watch Women's Health October 16, 2000