Over-screening and under-treating osteoporosis

A new study in the journal Menopause suggests that too many women are being unnecessarily screened for osteoporosis. It's an issue that requires attention because, when costly bone scans are performed on a population in which thinning bones are common, this can lead to false positives that result in women being treated for a disease they don t actually have.

Most guidelines suggest that women at age 65 and older need a scan every two years to determine their bone density. Younger women who have other risk factors (low body weight, early menopause, smoking, alcohol consumption, rheumatoid arthritis, a family history of osteoporosis, or a personal history of fragility fractures) should begin screening at age 50. However, in a study of 615 women who were screened in Hartford, CT, 41 percent did not meet these criteria. Equally troubling was the rate of under-treatment: 35 percent of the women who did meet expert guidelines for osteoporosis treatment were not on any kind of treatment.

While the authors of the study aren t certain what accounts for the disparity between guidelines and practice, they underscore how important it is for both women and their doctors to be aware of these guidelines. ACSH's Dr. Gilbert Ross also points out that the level of under-treatment could well be due to the persistent misconception of the risks and side-effects associated with hormone replacement therapy and bisphosphonate medications like Fosamax. These risks are actually quite low, he says, and they re generally outweighed by the benefits. Doctors need to be more assiduous about adhering to osteoporosis screening guidelines and after discussing the benefits and risks of treatment to prevent fractures making sure that those patients who need treatment are actually taking their medications.