November 14, 2014
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Frequent BMD tests unnecessary for younger postmenopausal women with good scores

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Postmenopausal women not diagnosed for osteoporosis on an initial bone mineral density test are unlikely to sustain a major osteoporotic fracture or to reap benefit from frequent re-screening before age 65 years, according to research published in Menopause.

“Bone density screening is a helpful test for younger postmenopausal women under age 65, but because the most serious types of broken bones (hip and spine fractures) are rare before age 65, younger postmenopausal women do not need bone density screening as often as women aged 65 and older,” Margaret Lee Gourlay, MD, MPH, of the University of North Carolina, Chapel Hill, told Endocrine Today.

Margaret Gourlay

Margaret Lee Gourlay

Gourlay and colleagues from other institutions evaluated 4,068 postmenopausal women from the Women’s Health Initiative bone mineral density (BMD) cohort study. The women, aged 50 to 64 years, had no history of hip or clinical vertebral fracture and were not receiving antifracture treatment at baseline. BMD tests were performed from 1993 to 2005, with a fracture follow-up period through 2012; concurrent BMD and fracture follow-up lasted a maximum of 11.2 years.

The researchers looked at the time for 1% of women to sustain a hip or clinical vertebral fracture, and the time for 3% of women to sustain a major osteoporotic fracture, before starting treatment; adjustments were made for clinical risk factors and competing risks taken into account. Separate analyses were conducted for women with and without osteoporosis on their first BMD test.

The adjusted estimated time for 1% of women to have a hip or clinical vertebral fracture was longest for women aged 50 to 54 years without baseline osteoporosis (12.8 years; 95% CI, 8-20.4), followed by women aged 60 to 64 years without baseline osteoporosis (7.6 years; 95% CI, 4.8-12.1) and all women aged 50 to 64 years with baseline osteoporosis (3 years; 95% CI, 1.3-7.1). Major osteoporotic fracture results were similar.

“Our findings suggested that some younger postmenopausal women with good bone density scores, T-scores above -1.5, can wait 5 years or longer for their next test because they are very unlikely to break a bone during that period,” Gourlay said.

Although less than 10% of women in the cohort had osteoporosis at baseline, the subgroup had a higher immediate risk of major fracture. The researchers noted that using age and baseline T score to determine screening frequency would maximize the clinical utility of BMD testing in younger postmenopausal women.

“Our study is important because it allows doctors to choose a bone-density testing frequency based on research data instead of guessing,” Gourlay said. — by Allegra Tiver

Disclosure: The project was funded by the National Center for Research Resources and by the National Center for Advancing Translational Sciences, NIH. The Women’s Health Initiative was funded by the National Heart, Lung, and Blood Institute, NIH, US Department of Health and Human Services.