The USPSTF recommends that women age 65 and older be screened routinely for osteoporosis.  This group also recommends that routine screening begin at age 60 for women at increased risk for osteoporotic fractures.

These recommendations are even more urgent since most women are being taken off the combination of estrogen and progesterone.  (Those women that are just on estrogen alone are still awaiting the results of the study to be released in the future concerning risks and benefits of estrogen alone.)

The USPSTF made no recommendation for or against screening for osteoporosis in postmenopausal women who were younger than 60 or in women age 60-64 who are not at increased risk for osteoporotic fractures. 

The exact risk factors that should trigger screening are difficult to specify based on evidence.  Lower body weights, i.e., weight lower than 154 pounds, is the single best predictor of low bone mineral density.  At any given age, African-American women on average have higher bone mineral density than white women and are less likely to benefit from screening.

Among different bone-measurement tests performed at various sites in the body, bone density measured at the femoral neck of the hip by dual energy x-ray absorptiometry (dexa) is the best predictor of hip fracture and is comparable to forearm measurements for predicting fractures at other sites.  Recent data suggests that peripheral bone density testing in the primary-care setting can also identify postmenopausal women who have a higher risk of fracture over the short term.  Peripheral testing that is done at the Walter Aument Family Health Center is that of ultrasonography of the heel. 

No studies have evaluated the optimal intervals for repeated screening.  A minimum of two years may be needed to reliably measure a change in the bone mineral density.  There also is no data to determine the appropriate age to stop screening.  Patients who have received a diagnosis of osteoporosis fall outside the context of screening, but may require additional testing for diagnostic purposes or to monitor response to treatment.

Many providers today are suggesting 1500 milligrams per day of calcium for the older women along with 400 to 800 international units of Vitamin D daily.  If you have thinning of the bones, however, in the form of osteopenia or osteoporosis, just taking calcium and Vitamin D will not be enough for treatment.  Your doctor has multiple medications at his or her disposal to help treat loss of bone density, in addition to the calcium and Vitamin D.

There is no question that loss of bone mineral density in the form of osteopenia or osteoporosis is an epidemic in our country today.  In addition to prescription medicines for treatment, and the baseline intake of calcium and Vitamin D, one should try to live an active lifestyle.  It has also been shown that smokers have a higher incidence of loss of bone mass.  Alcohol also seems to thin the bones. 

One of the reasons that we try to prevent osteoporosis is that up to 25% of those who fracture a hip may be dead within a year.  Most of the time the death is caused from complications of being immobile after the fracture.   For example, one is more prone to develop phlebitis, clots that may go to the lung, pneumonia or urinary tract infections.   Some studies also show that over 50% of patients who fracture their hip end up in a nursing home after the fracture.