OsteoEd

Practice Cases

Whom to Screen

Laurel Desnick, MD Literature reviewed January 15, 2007. Updated January 15, 2009

A 65-year-old woman comes in for a preventive health exam. She has hypertension and takes metoprolol as her only medication. She does not drink alcohol or smoke. She exercises three times weekly, and rates her overall health as excellent. She has never had a fracture or used corticosteroids. There is a family history of diabetes in both parents but otherwise it is unremarkable.

Click one of the video links to see Dr. Hal Bergen speaking about the risk factors in his wife's case.

Click an answer under each question.

  1. Does she need screening for osteoporosis?

    • Option A Yes, age 65 is the appropriate time to begin screening.
    • Option B No, she is extremely healthy with a great lifestyle and doesn't need it.
    • Option C No, it is too late. She should have been screened at menopause.

  2. With further questioning, the woman says she has already had osteoporosis screening at her church health fair. They checked her bone density at the wrist and told her she had osteoporosis. Are you ready to prescribe treatment?

    • Option A Yes. The test she had is reliable and she should begin treatment.
    • Option B No. The test she had is called a pDXA and it may be helpful in predicting decreased bone density. She should have a confirmatory test with a DEXA of the central skeleton before treatment is considered.
    • Option C No. The test she had is called a pDXA and is not at all accurate for predicting fracture.

  3. If her hip DXA did not show osteoporosis, when would you screen her again?

    • Option A In 2-5 years, depending on her T score and risk factors.
    • Option B Follow up screening is not necessary because if she does not have osteoporosis by age 65, she most likely will never develop it.
    • Option C In one year, as osteoporosis develops quickly after age 65.

  4. Is screening for osteoporosis recommended for elderly men without risk factors?

    • Option A No, because men rarely get osteoporosis.
    • Option B Yes, starting at age 70, because men develop osteoporosis approximately 5 years later than women.
    • Option C No, because studies addressing this have not been done in men.
Key Points
Last edited July 03, 2009