Who should I screen for osteoporosis?

Osteoporosis is most common in Asian and Caucasian women over the age of 65. That being said, everyone, even men, merits consideration of whether a screening test is necessary.

Risk factors that raise the likelihood of osteoporosis:

  • a thin, small-boned frame
  • early menopause (<45) either naturally or through surgical removal
  • low calcium diet
  • age >65
  • cigarette smoking
  • prolonged ETOH use
  • certain medications (such as steroids)

The FRAX calculator can help determine risk. If you like numbers, a white woman >65 years has a 10-year fracture risk of 9.3%, so anyone with a risk at least equal to that should be screened.

Screening for osteoporosis consists of a DXA scan. Ultrasound of the calcaneus (heel) is probably just as good, but there’s no evidence correlating it with diagnosis and management thereafter.

Osteoporosis prevention is most important BEFORE the age of 20! This is when the foundation of bone density is established. Calcium, Vitamin D, and weight-bearing exercises are important for maintaining bone strength. In patients who are osteoporotic, there are several medications that can be discussed with patients, each with their own benefits and risks:

  • bisphosphonates
  • PTH
  • raloxifene
  • estrogen

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