The recently reported study on bone density testing in the New England Journal of Medicine (NEJM) may have inadvertently resulted in confusion about the use and recommended frequency of an important diagnostic tool used for osteoporosis, a very serious condition that affects many women.
The recommendations regarding the frequency in which older women should receive bone density scans in the study could, in some instances, be misread as being unnecessary by some women, whereas preventive screening for bone health should indeed be considered as a major part of every woman’s preventive health plan, just like a mammography is for ensuring healthy breasts.
It is the scientific society’s duty to both produce important bone health research as well as to accurately and clearly interpret scientific findings for the public and the medical community. Together, decades have been spent on gaining an understanding of the science related to bone health. The same applies to recommendations made for the treatment of bone conditions and diseases, such as medications, technologies and other diagnostic tools.
The study in question indicated that women aged 65 years and older, whose first bone density screening tested normal, would be safe to wait for as long as 15 years before needing another test. Even though this is great news for post-menopausal women with good or mildly low bone density, the researchers warn this only applies to less than half of the women in the U.S. who are aged over 65 years, and that even for those women, other risk factors must be considered. According to the ASBMR, it is crucial that patients and their medical practitioners understand precisely that bone density testing is recommended for:
- Women who had any kind of fractures at the age of 45 or older
- Women with a family history of hip fractures or other bone-related disease, who should start osteoporosis testing at the age of 50.
- Women already diagnosed with low bone density or osteoporosis. The frequency of bone density testing depends on the level of bone density as well as whether or not other risk factors exist. Generally testing is once every two years.
- All women above the age of 65 years. Even though Medicare covers bone density testing as a preventive benefit, only 13% of women eligible under Medicare receive a baseline-screening test.
The recent media coverage of the NEJM study also omitted the fact that the recommendations for future screenings were based on results for women who received a baseline screening at age 65. The sad truth is that just 13% of 65-year old women on Medicare actually receive this baseline screening, which basically means that the remaining 87% of women are not so fortunate and will be unaware of whether they are at risk until they have a fracture.
Currently, almost 10 million Americans are diagnosed with osteoporosis with many people not even aware that they are at risk. An additional 34 million people suffer from low bone mass, which makes them more susceptible to osteoporosis. One in two women and one in four men aged 50 years or older will suffer a fracture due to osteoporosis without intervention.
The health and financial consequences for osteoporosis are serious, for instance, one out of five seniors with a hip fracture die from related complications within 12 months. Experts say that whilst osteoporosis accounted for an estimated two million fractures and $19 billion in costs in 2005, the prognosis is that by 2025 osteoporosis will be responsible for about three million fractures and $25.3 billion in annual costs.
According to the ASBMR, the physical and economic cost of osteoporosis can be lowered by sustained investment in research and preventative efforts.
Written by Petra Rattue