Ask Dr KK: How often to repeat BMD test for osteoporosis?

Ask Dr KK: How often to repeat BMD test for osteoporosis?

• Assessment of fracture risk in all adults is important.

• BMD-independent risk factors are advanced age, previous fragility fracture, glucocorticoids, risk of falls, smoking, alcohol, and family history of fracture. 

• Screen with BMD in all women 65 years of age and older

• Screen with BMD in postmenopausal women less than 65 years if one of the above risk factors is present

• Do not perform 

• routine BMD measurements in premenopausal women 

• Do not perform routine BMD measurements in all men.

• Measure BMD in men who have clinical manifestations of low bone mass, such as radiographic osteopenia, history of low trauma fractures, and loss of more than 1.5 inches in height, as well as in those on long-term glucocorticoid therapy, androgen deprivation therapy for prostate cancer, hypogonadism, primary hyperparathyroidism, hyperthyroidism, and intestinal disorders

• For screening BMD use DXA

• Go for DXA of hip and spine

• Measurement of the hip alone could be sufficient in older individuals. 

• In women and men with low bone mass (T-score -2.00 to -2.49) at any site or who have risk factors for ongoing bone loss (steroid use, hyperparathyroidism) do follow-up BMD every two years as long as the risk factor persists 

• In women 65 + years at baseline with low bone mass (T-score -1.50 to -1.99) at any site, and with no risk factors for accelerated bone loss, go for follow-up DXA in three to five years

• In women 65 years + of age with normal or slightly low bone mass (T-score -1.01 to -1.49) at baseline and no risk factors for accelerated bone loss go for follow-up DXA in 10 to 15 years 

• A 65-year-old woman with a femoral neck BMD T-score of -1.01 to -1.49 and no clinical risk factors for fracture has 10-year absolute risk of hip fracture of only 0.9 percent.[Source Uptodate]