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Osteoporosis screening recommendations
National Osteoporosis Foundation (NOF) The NOF recommends measurement of BMD (DXA of the hip and spine) in[1]:
• Women aged 65 years and older and men age 70 and older, regardless of clinical risk factors
• Younger postmenopausal women, women in the menopausal transition, and men age 50 to 69 with clinical risk factors for fracture
• Adults who have a fracture after age 50
• Adults with a condition (eg, rheumatoid arthritis) or taking a medication (eg, glucocorticoids in a daily dose ≥5 mg prednisone or equivalent for ≥3 months) associated with low bone mass or bone loss
International Society for Clinical Densitometry (ISCD) The ISCD recommends measurement of BMD (DXA of the hip and spine) in[2]:
• All women 65 years and older and men 70 and older regardless of risk factors
• Postmenopausal women and men 50 to 70 years when risk factors are present
• Adults with a fragility fracture
• Adults with a condition or taking a medication associated with low bone mass or bone loss
• Anyone being considered for pharmacologic therapy for osteoporosis
• Anyone being treated for osteoporosis to monitor response to therapy
• Anyone not receiving therapy when evidence of bone loss would lead to treatment
• Women in the menopausal transition if there is a specific risk factor associated with increased fracture, such as low body weight, prior low-trauma fracture, or high risk medication
• Postmenopausal women discontinuing estrogen should be considered for bone density testing
• The 33 percent forearm (1/3 radius) site is recommended in the following cases:
- If hip and/or spine cannot be measured or interpreted
- Hyperparathyroidism
- Severe obesity (over the weight limit of DXA table)
Association of Clinical Endocrinologists (AACE) AACE recommends measurement of BMD (DXA) in[4]:
• All women 65 years and older
• Any adult with a history of fracture not caused by severe trauma
• Younger postmenopausal women with clinical risk factors for fracture
• The lumbar spine (PA) and proximal femur are recommended sites of measurement
United States Preventive Services Task Force (USPSTF) USPSTF recommends measurements of BMD in[5]:
• All women ages 65 and older
• In addition, they recommend screening in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors
• The best site to screen is not mentioned, although the report agrees that DXA of the hip is the best predictor of hip fracture
American Academy of Family Physicians The American Academy of Family Physicians recommends measurement of BMD in[6]:
• Women ages 65 and older
• Women 60 and older at increased risk for osteoporotic fracture
National Institutes of Health The NIH recommends[7]:
• BMD measurements for individuals at high risk for osteoporosis. They do not recommend universal screening.
UK National Osteoporosis Guideline Group (NOGG) The UK National Osteoporosis Guideline Group (NOGG) does not recommend population screening. They are in favor of performing BMD measurements using a case finding strategy based upon age-specific fracture probability thresholds[8].
Canadian Osteoporosis Society The Canadian Osteoporosis Society recommends BMD measurement in[9]:
• Postmenopausal women ≥65 years
• Men ≥65 years
• Younger men and women with additional clinical risk factors for fracture
References:
  1. National Ostoporosis Foundation. 2013 Clinician's Guide to Prevention and Treatment of Osteoporosis. http://nof/public/content/resource/913/files/580.pdf (Accessed on November 14, 2013).
  2. International Society for Clinical Densitometry. 2013 ISCD Official Positions - Adult. www.iscd.org/official-positions/2013-iscd-official-positions-adult/ (Accessed on November 14, 2013).
  3. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Postmenopausal Osteoporosis. www.aace.com/pub/pdf/guidelines/OsteoGuidelines2010.pdf (Accessed on January 10, 2011).
  4. U.S. Preventive Services Task Force. Screening for Osteoporosis Recommendation Statement. www.uspreventiveservicestaskforce.org/uspstf10/osteoporosis/osteors.htm (Accessed on February 10, 2011).
  5. American Academy of Family Physicians. Recommendations for clinical preventative services. www.aafp.org/exam.xml (Accessed on January 10, 2011).
  6. www.consensus.nih.gov (Accessed on January 10, 2011).
  7. National Osteoporosis Guideline Group (NOGG). www.shef.ac.uk/NOGG/index.html (Accessed on June 29, 2011).
  8. Papaioannou A, Morin S, Cheung AM, et al. 2010 Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: Summary. CMAJ 2010; 182:1864.
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