Osteoporosis Screening Guidelines Miss Younger At-Risk Women

Bone mass loss during osteoporosis causes your skeletal frame to become thin, brittle, and fragile. Discovering this condition early enough to prevent fractures is key. But researchers found that current osteoporosis screening guidelines and tools fail to identify many younger postmenopausal women who are at risk for osteoporosis-related bone breakages. Another study determined that body mass index (BMI) is a better predictor.

Various Forecasting Methods Fall Short

The U.S. Preventive Services Task Forces (USPSTF) recommends that all women aged 65 and older should receive testing and treatment for low bone mineral density. It also advises that postmenopausal women aged 50 to 64 should have bone mineral density screenings if their 10-year risk for hip, spinal, forearm, or wrist fracture is 9.3 percent or higher, according to its Fracture Risk Assessment (FRAX) tool.

who analyzed data on over 62,000 postmenopausal women aged 50 to 64 found that these osteoporosis screening guidelines isolated only about 26 percent who suffered major osteoporosis-related fractures within 10 years. The older Simple Calculated Osteoporosis Risk Estimation (SCORE) tool and the Osteoporosis Self-Assessment Tool (OST) weren’t much better, identifying about 39 and 40 percent of at-risk women, respectively. When the researchers broke the data into more specific age groups, they discovered that current resources were least effective for women between 50 and 54.

This research team concluded that these for older women aren’t as good at gauging risks in younger postmenopausal women who have higher fracture risks. “Neither the USPSTF nor the other two screening strategies performed better than chance alone in discriminating women who did and did not have subsequent fractures,” the authors reported.

Their results underscore the crucial necessity of evaluating other approaches and finding additional resources that better target at-risk younger postmenopausal women. Doctors need accurate tools that help predict who might suffer osteoporotic injuries so they can pinpoint these patients for preventive measures, said study author Dr. Carolyn Crandall, professor of medicine at University of California School of Medicine.

Body Mass Index Outshines Other Techniques

Previous research outcomes have suggested that low body mass index (BMI) may be a risk factor for osteoporosis. BMI is a measure of body fat based on height and weight. A compared the use of BMI as a predictor for osteoporosis development with current screening strategies including the FRAX tool without bone mineral density (BMD), a risk factor-based approach, and the OST. They found that BMI demonstrated higher sensitivity than the other screening modalities in predicting osteoporosis in younger postmenopausal women.

The researchers surveyed women about their ages, weights, heights, races, histories of fragility fracture after age 50, parental hip fractures, previous or current long-term steroid use, current smoking status, and rheumatoid arthritis histories. They used dual-energy x-ray absorptiometry (DXA) results as the gold standard for screening. Of the study’s 445 postmenopausal women aged 50-64, 38 had osteoporosis, and three had histories of fragility fractures. The research team reported that sensitivity and specificity were 24 percent and 83 percent for FRAX, 66 percent and 62 percent for the risk factor method, and 79 percent and 56 percent for OST, respectively.

When applying the receiver operating characteristic (ROC) curve, the investigators identified BMI measurements of 28 and below as the best osteoporosis predictors. Use the National Heart, Lung, and Blood Institute’s online to figure your value. Sensitivity and specificity were 95 percent and 38 percent, respectively. The scientists also noted that BMI alone, FRAX, the risk factor method, and OST required nine, nine, seven, and seven women, respectively, to undergo DXA to identify one woman with osteoporosis.

“BMI is a very important predictor of osteoporosis in the younger postmenopausal population,” the researchers concluded. Using a BMI of 28 as the cut-off point corresponds to much higher sensitivity, compared to other screening methods without increasing costs significantly.

Risk Factors

According to the U.S. Centers for Disease Control and Prevention, these factors increase your osteoporosis risk:

• Postmenopausal
• Caucasian
• Older age
• Small frame
• Dietary calcium deficiency
• Inadequate exercise

Diagnosis and Treatment

Based on your BMI and risk factors, you doctor can determine if you need an early BMD scan. If you have osteoporosis, Evista (Raloxifene) can reduce your fracture chances while also decreasing your breast cancer risk. Buy Evista and bone-friendly calcium and vitamin D supplements online.

Improve Your Bone Health

Dr. Andrew Weil offers tips to prevent or manage osteoporosis.

• Fruits and vegetables: Research associates their potassium, magnesium, vitamin C, and beta-carotene content with higher total bone mass.
• Calcium: Consume yogurt, milk, and calcium-fortified orange juice. Eat more dark-green vegetables like collard greens, bok choy, and broccoli. Take a calcium supplement if you don’t eat at least three servings of dairy and/or calcium-fortified foods per day, you’re postmenopausal, or have a family history of osteoporosis.
• Vitamin D: Supplement with 2000 IU daily.
• Magnesium-rich foods: Good sources include spinach, tofu, almonds, broccoli, lentils, pumpkin seeds, and sunflower seeds.
• Vitamin-K-rich foods: The best sources are leafy greens, but most vegetables are beneficial.
• Sodium: To reduce your intake, avoid salty processed foods and fast food, and don’t salt food before tasting it.
• Caffeine: Limit your consumption.
• Alcohol: Avoid alcoholic beverages or drink in moderation.
• Exercise: Do at least 30 minutes of weight-bearing activities such as walking, weight training, and calisthenics most days of the week.