Although a recent study in the New England Journal of Medicine suggests women with normal results ondual-energy X-ray absorptiometry scans at age 67 years and older may wait as much as 15 years for a second test, some physicians have cautioned such an interval is inappropriate for many adults.
E. Michael Lewiecki, MD, FACP, and co-authors recently wrote in an article in the Journal of Bone and Mineral Research (JBMR) that monitoring of bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA) should be performed at intervals shorter than 15 years for many individuals, according to a Wiley-Blackwell news release.
“Policy makers and patients who are concerned that overuse of medical tests may be driving up health care costs may be tempted to conclude that DXA scanning should be done less frequently,” Lewiecki stated in the release. “In fact, just the opposite is true. Appropriate DXA screening reduces health care costs.”
Those who should undergo screening at shorter intervals, the release noted, include younger post-menopausal women at high risk for fracture, patients whose DXA scans indicate BMD substantially below normal, those with prior fracture or clinical risk factors for fracture, and those patients already receiving osteoporosis drug therapy.
According to the release, the authors of the article wrote that many women — even those at risk for osteoporosis — never receive initial DXA screening. The result, they noted, is that osteoporosis often goes undiagnosed and untreated, leading to fractures that are dangerous to patients and costly to treat.
The authors reportedly agreed that a recommendation for extended intervals between BMD tests is reasonable for women who fit the profile of those in the New England Journal of Medicine study, but added these recommendations should not be applied to all post-menopausal women.
“The JBMR has a responsibility to address important scientific and clinical issues regarding bone disease,” Thomas L. Clemens, PhD, JBMR editor-in-chief, stated in the release. “As Dr. Lewiecki and colleagues point out, there are important limitations and exceptions to a recommendation of very long intervals between DXA testing.”
- Lewiecki EM, Laster AJ, Miller PD, Bilezikian JP. More bone density testing is needed, not less. J Bone Min Res. 2012. doi: 10.1002/jmbr1580.