Diagnosing the Problem
Who should be tested?
Once a patient is identified as being at-risk for bone disease, further evaluation must be done to determine whether the risk factors are related to osteoporosis and osteopenia or to another disease. The National Osteoporosis Foundation guidelines indicate that Bone Mineral Density Measurement should be performed on all at-risk patients.
Who should have a BMD test?1
| Women |
Men |
| Age 65+, regardless of clinical risk factors |
Age 70+, regardless of clinical risk factors |
| Age 51+, who have a fracture | Age 51+, who have a fracture |
| All ages with condition (e.g., rheumatoid arthritis) associated with low bone mass or bone loss |
All ages with condition (e.g., rheumatoid arthritis) associated with low bone mass or bone loss |
| All ages taking a medication (e.g. glucocortids ≥5 mg/day for ≥3 months) associated with low bone mass or bone loss |
All ages taking a medication (e.g. glucocortids ≥5 mg/day for ≥3 months) associated with low bone mass or bone loss |
| All ages being considered for pharmacologic therapy for osteoporosis |
All ages being considered for pharmacologic therapy for osteoporosis |
| All ages of those being treated for osteoporosis, to monitor treatment |
All ages of those being treated for osteoporosis, to monitor treatment |
| All ages for those whom evidence of bone loss would lead to treatment, and yet is not receiving therapy |
All ages for those whom evidence of bone loss would lead to treatment, and yet is not receiving therapy |
| Younger postmenopausal, about whom you have a concern based on their risk factor profiles |
Ages 50-70, about whom you have a concern based on their risk factor profiles |
| Perimenopausal, with increase fracture risk factors like low body weight. Prior low-trauma fracture or high risk medication |
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| Postmenopausal women discontinuing estrogen |
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World Health Organization (WHO) Fracture Risk Assessment Tool (FRAX)2
Developed by WHO the FRAX tool helps to evaluate fracture risk of patients. This tool is based on individual patient models integrating the risks associated with clinical risk factors and bone mineral density (BMD) at the femoral neck. It has been developed by studying population-based cohorts (Europe, North America, Asia and Australia).
It is available as a computer-driven tool at http://www.sheffield.ac.uk/FRAX/. Several simplified tables are also available by age group and can be downloaded for office use.