Questioning the Frequency of Bone Density Testing

As we age, bones lose minerals and protein. That makes them more fragile and susceptible to fracture. When the condition becomes debilitating, it’s called osteoporosis, and in its most severe expression can make bones so brittle that they can break when you sneeze.

Because there’s a direct connection between the lower hormone levels of menopause and loss of bone mass, more women than men are at risk for osteoporosis; one sign of it is a hunched upper back characteristic of spine fracture and compression, commonly called “dowager’s hump.”

Bone mineral density (BMD) tests can detect problems before they become debilitating-people whose test shows too much bone deterioration can reduce their risk of fractures, especially the hip fractures that often lead to complications and higher mortality, by taking medication. But a recent study suggests that bone density monitoring is overused.

As discussed on Time.com, doctors recommend that people older than 65 get BMD screenings every two years. Researchers analyzed about 800 people, average age of 75, from the Framingham Osteoporosis Study who were not being treated for bone loss. They had two BMD screens of their thigh bones in four years. The percentage of patients whose risk status changed between the two was very small.

The research was published in the
Journal of the American Medical Association (JAMA).

Basically, the second tests didn’t add information to the original BMD measurement that would help doctors determine the participants’ risk of a fracture over the following 12 years. In that span, the average BMD dropped by less than 1% each year.

So for older patients not being treated for active osteoporosis, the researchers concluded that repeat BMD screening every two years probably wasn’t justified. If repeated bone scans are valuable, it isn’t clear what the optimum interval is.

The researchers noted that because the subjects were not being treated for bone loss, their results might not apply to people using osteoporosis medications, which pose considerable risks of their own (see our blog, “Fosamax Warning Renewed.”) And because the study concerned only Caucasians, the results might not apply to other demographic groups.

The study was relatively small, so the protocol should be repeated before any sweeping conclusions can be drawn or a definitive best-practice statement made. But if the results are replicated in a larger study, the current guidelines and the willingness of insurers to pay for frequent BMD testing could change.

Medicare covers BMD screening every two years, and 22 in 100 Medicare beneficiaries, according to Time, have the tests repeated within three years.

No one should have to suffer from osteoporosis if a screening test can prevent it, but it’s possible that BMD diagnostic tests , like so many other do-it-by-default medical procedures, are simply unnecessary and unnecessarily expensive.

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