November 2003 · Vol. 15, No. 11Who is at risk of fracture?
Avoid 6 pitfalls of osteoporosis screening
Easily misunderstood symptoms, overlooked history and lifestyle clues, mistaken choice of densitometry site and method—these and other snags can trip up efforts to screen patients adequately and start intervention early.
JUDI
L.
CHERVENAK,
MDDr. Chervenak is assistant professor of obstetrics, gynecology, and reproductive endocrinology and infertility at Albert Einstein College of Medicine, Montefiore Medical Center,
Bronx, NY.
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KEY POINTS
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Dual-energy x-ray absorptiometry is the gold standard for bone density measurement.
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Don’t rely on bone densitometry alone to estimate fracture risk; combine it with thorough assessment of history and risk factors. Nonetheless, bone densitometry is vital, and can establish a baseline that is useful for monitoring therapy.
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When interpreting densitometry results, base the diagnosis on the lowest score obtained.
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Over her lifetime, a woman’s risk of hip fracture is greater than her risk of breast, endometrial, and ovarian cancer combined.
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Osteoporosis has claimed the spotlight. The sheer volume of information published in recent years is astounding. From clinical guidelines to mainstream media, the message is clear: Osteoporosis can be prevented and effectively treated if intervention is early enough. The key? Proper screening of women who may be at risk.
That’s where the difficulty begins. Amid a profusion of data, the simple how-to—and when-to—of screening can get lost. But osteoporosis is a potent threat. Over her lifetime, a woman’s risk of hip fracture is greater than her risk of breast, endometrial, and ovarian cancer combined. Since many women are discontinuing hormone replacement therapy in the aftermath of the Women’s Health Initiative, the risk seems likely to increase.
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