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Screening for osteoporosis

Michael Kleerekoper, MD
Section Editors
Clifford J Rosen, MD
Kenneth E Schmader, MD
Deputy Editor
Jean E Mulder, MD


Osteoporosis is a common disease that is characterized by low bone mass, microarchitectural disruption, and skeletal fragility, resulting in an increased risk of fracture. The goal of screening is to identify persons at increased risk of sustaining a low trauma fracture and who would benefit from intervention to minimize that risk.

Screening for fracture risk involves appropriate history, physical examination, standard biochemical and hematologic studies, and measurement of bone mineral density (BMD). The clinical history should include inquiring about possible secondary causes of bone loss, such as use of medications with potential adverse effects on bone health and family history of osteoporosis. A widespread approach to BMD screening alone has not been universally adopted, in part due to cost and questions regarding the efficacy of a broad population screening policy. The issues surrounding screening for osteoporosis in postmenopausal women and men are reviewed here. Controversies surrounding screening for osteoporosis in premenopausal women are reviewed separately. (See "Evaluation and treatment of premenopausal osteoporosis", section on 'Screening'.)

Detailed information about diagnosis, prevention, and treatment of osteoporosis is found elsewhere. (See "Clinical manifestations, diagnosis, and evaluation of osteoporosis in postmenopausal women" and "Clinical manifestations, diagnosis, and evaluation of osteoporosis in men" and "Prevention of osteoporosis" and "Overview of the management of osteoporosis in postmenopausal women" and "Treatment of osteoporosis in men".)


Osteoporosis is characterized by low bone mass, microarchitectural disruption, and increased skeletal fragility. In addition, the World Health Organization (WHO) has defined osteoporosis based upon dual-energy x-ray absorptiometry (DXA) measurements (table 1). The relative risk of fracture increases as BMD decreases. (See "Clinical manifestations, diagnosis, and evaluation of osteoporosis in postmenopausal women", section on 'T-score' and "Overview of dual-energy x-ray absorptiometry".)


The burden of suffering associated with osteoporosis is related to the increased incidence of fractures in individuals with low bone mass and microarchitectural deterioration. Fragility fractures are defined as fractures that occur following a fall from standing height or less or with no trauma. Although the greatest relative risk of fracture is in individuals with osteoporosis, the absolute number of fractures in those with bone mineral density (BMD) T-scores in the low bone mass (osteopenia) range is the same or greater than in those with T-scores in the osteoporosis range. (See 'Assessment of fracture risk' below and "Osteoporotic fracture risk assessment".)

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Literature review current through: Sep 2017. | This topic last updated: Mar 26, 2017.
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