Breaking a bone is frequently a catastrophic injury for an older patient. A hip fracture or a vertebral fracture frequently leads to a permanent decrease in mobility which starts an inexorable decline in health and independence. For that reason, fracture prevention is a critical part of the care of older people.
Osteoporosis, which is severely decreased bone density, is a major risk factor for fractures, especially in women over 65. Osteoporosis is also treatable, and there is good evidence that treating osteoporosis with bisphosphonates (a family of medicines which includes Fosamax, Actonel, and Boniva) prevents fractures.
So we know that testing bone density is important in women over 65. But we don’t know how frequently we should be recommending the test. Medicare pays for the test every two years, and in the absence of scientific information about how frequently the test is valuable, that has become the accepted default.
” target=”_blank”>Patients With Normal Bone Density Can Delay Retests, Study Suggests (NY Times)
” target=”_blank”>How Often Should Women Be Screened for Osteoporosis? (Wall Street Journal health blog)
” target=”_blank”>Medications for Osteoporosis (my summary in 2008)
* Definition of various levels of bone density according to T score
Bone Density T score
Normal greater than -1
Mild osteopenia between -1 and -1.5
Moderate osteopenia between -1.5 and -2
Advanced osteopenia between -2 and -2.5
Osteoporosis less than -2.5
Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice. Anything that I write is no exception. I’m a doctor, but I’m not your doctor.
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