DXA scan should be done at shorter intervals for women at high risk for fracture

Wiley-BlackwellMar 2 2012

Although a recent study suggests that women with normal results on dual-energy X-ray absorptiometry (DXA) scans at ages 67 and older may wait up to 15 years for a second test, a Viewpoint article published today in the Journal of Bone and Mineral Research (JBMR) cautions that such a lengthy interval is inappropriate for many adults.

Viewpoints allow experts to provide a new perspective on research. In their article, osteoporosis experts Drs. E. Michael Lewiecki, Andrew Laster, Paul Miller and John Bilezikian write that monitoring bone mineral density by DXA should be done at intervals much shorter than 15 years for many individuals. These include younger postmenopausal women at high risk for fracture, patients whose DXA scans indicate bone mineral density values substantially below normal, those with prior fracture or clinical risk factors for fracture, and patients already receiving osteoporosis drug therapy.

The article comments on research recently published in the New England Journal of Medicine (NEJM.)

"Policy makers and patients who are concerned that over-use of medical tests may be driving up health care costs may be tempted to conclude that DXA scanning should be done less frequently," said Dr. Lewiecki. "In fact, just the opposite is true. Appropriate DXA screening reduces health care costs."

Many women, even those at risk for osteoporosis, never receive an initial DXA screening, the authors of the JBMR article note, with the result that osteoporosis often goes undiagnosed and untreated leading to debilitating fractures that are dangerous to patients and costly to treat. Over 200 million people worldwide suffer from osteoporosis, including 10 million Americans, with two million related fractures occurring annually and treatment costs exceeding $18 billion.

While the authors agree that a recommendation for extended intervals between bone mineral density tests is reasonable for women who fit the rather restricted profile in the NEJM study, physicians should not apply these recommendations to all postmenopausal women. Bone mineral density testing by DXA is the international standard for assessing skeletal health, the authors note, citing research from both the Geisinger Health System Osteoporosis Disease Management Program and Kaiser Permanente of Southern California, which found that increases in testing reduced fracture rates and associated health care costs.

"The JBMR has a responsibility to address important scientific and clinical issues regarding bone disease," concluded Dr. Thomas L. Clemens Editor-in-Chief of the JBMR. "As Dr. Lewiecki and colleagues point out, there are important limitations and exceptions to a recommendation of very long intervals between DXA testing"