Bones About It

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Our bones are constantly being broken down and rebuilt. This process is called remodeling. As we age, in many people, the rate of bone breakdown eventually exceeds the rate of bone creation. This causes a condition called osteoporosis. Osteoporosis is a condition with severely low bone mineral density (BMD). People with osteoporosis are much more likely to have bone fractures, especially after a trauma like a fall. The two most common osteoporosis-related fractures are hip fractures and spinal compression fractures. Spinal compression fractures cause back pain that may last for months and, if multiple spinal fractures occur, may lead to curvature of the spine which causes a stooped posture. Hip fractures may lead to lifelong problems such as disability, chronic pain, and decreased quality of life. In addition, the rate of death within 12 months of a hip fracture is quite high.

In women, the decrease in estrogen levels that occurs during menopause leads to an increased rate of bone breakdown. For this reason, post-menopausal women have a greater risk of osteoporosis as opposed to men, and women who have not yet reached menopause. Other risk factors for osteoporosis include smoking, excess alcohol use, low body weight, and a history of a parent with a hip fracture. Recently, the United States Preventive Services Task Force (USPSTF) published a study that made recommendation for screening people for osteoporosis. The USPSTF puts out screening recommendations for various diseases and conditions. You may recall that not too long ago, I wrote a column about the USPSTF recommendations for screening men for prostate cancer, (they recommended that Prostate-Specific Antigen (PSA) screenings should not be done at all in most men).

The most common screening test for osteoporosis is a special type of x-ray test that measured bone mineral density. This test is called dual-energy x-ray absorptiometry, or DEXA for short. DEXA testing usually looks at “central” bones, usually the hip and spine. Peripheral DEXA tests that look at the forearm or heel are also done, however central bone testing is thought to be superior to peripheral. The USPSTF recommendations for osteoporosis screening applies to adults who do not have a history of fractures, do not have an increased risk of falls, do not have other conditions that may cause osteoporosis (i.e. thyroid disease), and are not taking medications that may cause osteoporosis (i.e. prednisone and other steroids). The USPSTF recommendations are as follows: all women 65 and older should be screened and women younger than 65 with risk factors (smoking, excess alcohol intake, low body weight, and a parent with a history of a hip fracture) should be screened. Again, all women selected for screening should be post-menopausal. The USPSTF did not make a screening recommendation for men because there is insufficient evidence for screening men. DEXA screening has few, if any, harms and is non-invasive and painless. For more information go to:

www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/osteoporosis-screening1

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