Older women may need fewer bone tests

The bone-thinning condition known as osteoporosis can be a big problem for older people. Fragile bones are prone to breaking. In older individuals, broken bones are more than an annoyance—a broken hip can lead to loss of independence, and sometimes to death.

Because thinning bones are so common (affecting 44 million Americans) and can be so damaging, older folks are urged to have their bones checked with a test that measures bone density. The denser the bone, the stronger it should be.

Osteoporosis often can be prevented and there are a number of effective treatments. Current guidelines recommend routine testing for women beginning at age 65 and men starting at age 75.  There is no clear agreement, however, on how often to repeat these tests.

Researchers with the Study of Osteoporotic Fractures Research Group wondered how frequently bone mineral density testing should be repeated. They looked at records for nearly 5,000 women who had a first bone mineral density test at age 67 or older; none had osteoporosis. Some of the women had perfectly normal bone density, and some had osteopenia—bone mineral density that was below normal, but not low enough to qualify as osteoporosis. The women were followed for almost 17 years. The researchers found that when a woman should have her next bone mineral test depends on the result of the one she just had:

• Every 15 years if the result is normal or shows mild osteopenia. Fewer than 1% of women with normal results and 5% of women with mild osteopenia developed osteoporosis within 15 years.
• Every five years if the test shows moderate osteopenia.
• Every year if the test shows severe osteopenia.

The results were published in the New England Journal of Medicine.

Refining the interval

Most screening tests (tests that try to detect health problems before they become apparent) are not a one-time thing. If you have a colonoscopy, your doctor will probably tell you to have another in 10 years, even if the result is normal. Mammograms are repeated every year or two. Cholesterol tests, prostate cancer screening, Pap smears, and others are routinely repeated. If the results are abnormal, you’re probably in for more frequent tests.

The results of the new study have the potential to change how often doctors check for osteoporosis. There’s little reason to order a test over and over if the result is unlikely to change. And limiting tests that aren’t needed could provide enormous savings.

Prevention is key

Some people develop osteoporosis because they are genetically predisposed to it. For most people, though, the disease can be prevented. Talk to your doctor about any factors that may affect your personal risk of osteoporosis. Ask about what tests, if any, you should have. If you are having repeated bone mineral density tests, review this new study with your doctor.

Here are several ways to keep your bones strong and healthy:

• Do weight-bearing exercise, like walking or running
• Get enough calcium and vitamin D in your diet (or take supplements as recommended by your doctor)
• Don’t smoke
• If you drink alcohol, keep it moderate (no more than two drinks a day for men, no more than one for women)
• Have your thyroid checked (because an overactive thyroid can lead to osteoporosis)