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Study: Elderly May Need Only One Bone Scan

September 25, 2013
Written by: , Filed in: Musculoskeletal Radiology, Practice Management
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Should older adults get a bone mineral density (BMD) scan to screen for osteoporosis? Absolutely, say the authors of a new study. Should the scan be repeated in a few years to see if the risk of bone fractures has changed? That’s “unclear,” the authors say.

An article about the study, published online today in JAMA—The Journal of the American Medical Association, says:

We conclude that repeating a BMD test after 4 years would rarely change the clinical management of osteoporosis based on risk scores of hip fracture.

Older people commonly get a bone mineral density scan every two years, mostly because that’s how often Medicare will pay for one. But it’s the baseline scan, not follow-up scans, that is the best predictor of whether older adults will suffer major bone fractures, said lead author Sarah D. Berry, MD, a researcher at the Institute for Aging Research in Boston.

“Our research, which was made possible through the routine clinical examinations performed as part of the Framingham Heart Study, tells us that the initial BMD test does a very good job of identifying people at risk for fracture,” Dr. Berry said, as quoted in an institute news release. “The current clinical practice of repeating the test every two years may not be necessary in adults over age 75 who aren’t being treated for osteoporosis.”

The researchers studied 310 men and 492 women who were part of the Framingham Osteoporosis Study, an offshoot of the Framingham Heart Study that uses ancillary data collected during physical exams of the heart study participants. The participants each had a baseline dual-energy X-ray absorptiometry (DEXA) test for bone mineral density, then a second scan an average of 3.7 years later. The researchers followed the participants for 10 years to record any hip, spine, forearm, or shoulder fractures.

Mean age of the participants at the baseline test was 74.8 years.

“Individuals with the biggest changes in their fracture risk assessment scores were those individuals that would have already been classified at high risk based on an initial DEXA screening test and updated clinical characteristics,” said Dr. Berry in a JAMA podcast. “Repeating a bone mineral density measure over four years provided little additional data beyond the baseline measure of bone mineral density.”

The authors did note, “We recognize that detecting BMD loss would have been paramount for the small numbers of individuals reclassified by a second BMD test who went on to experience a fracture.”

Therefore, they suggest, “Further study is needed to determine an appropriate rescreening interval and to identify individuals who might benefit from more frequent rescreening intervals.”

Related CME seminar (up to 21 AMA PRA Category 1 credits™): UCSF Neuro and Musculoskeletal Imaging

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