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Study: Bone Scans Can Wait For Most Women

January 20, 2012
Written by: , Filed in: Musculoskeletal Radiology
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Medicare will pay for a bone-density scan every two years, so that’s how often many woman 65 or older get one. Not so fast, says a new study in The New England Journal of Medicine.

The study followed 4,957 women 67 or older who did not have osteoporosis at the beginning of the study. Of the women who began with normal bone density, fewer than 1 percent developed osteoporosis within 15 years. Of those with mildly low bone density, known as osteopenia, fewer than 5 percent developed osteoporosis within 15 years.

But of those with significantly low bone density, close to the osteoporosis point, 10 percent crossed over into osteoporosis in just one year.

Among the implications of the study, according to Steven Cummings, MD, its principal investigator and an emeritus professor of medicine, epidemiology, and biostatistics at the University of California, San Francisco, is this:

Bone density testing has been oversold.

Dr. Cummings was quoted in a New York Times article.

The researchers concluded that women 67 or older whose initial scan shows normal bone density could wait as long as 15 years before getting rescanned. Women in the moderate-risk group should get another scan about every five years. And women in the high-risk group should get rescanned as often as every year.

No major medical body has actually recommended a bone-density scan—dual-energy X-ray absorptiometry—every two years. An NPR report on the new study quoted Cliff Rosen, MD, a bone specialist at the Maine Medical Center’s Research Institute in Scarborough, Maine, as saying the notion that bone scans should be done every two years “didn’t come from anything scientific.”

In part, the push for bone scans came from the pharmaceutical giant Merck after its drug Fosamax, the first really effective drug treatment for osteoporosis, was approved in 1995. A 2009 NPR story told that fascinating tale.

Margaret Gourlay, MD, of the University of North Carolina, the study’s lead author, emphasized to NPR that older women should get a baseline bone-density screening. She noted that only 13 percent of Medicare-eligible women (i.e., 65 or older) get a bone scan in any given year and added:

We’re hoping that people will just think about the test and that patients will ask for a first test more often. This is forgotten by both patients and primary-care physicians.

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“Waxy” but readable. So says one radiologist about new low-radiation CT images. For details, see today’s Facebook post.

Related seminar: Neuro & Musculoskeletal Imaging

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