As part of the Choosing Wisely campaign, the American Academy of Family Physicians has released our top five recommendations for tests and procedures that patients and doctors should question. Today, I am focusing on the third issue: bone densities. The recommendation is this:
Do not use dual-emission X-ray absorptiometry (DEXA) in women younger than age 65 or men younger than 70 with no risk factors.
We now know that using these bone density scans are not cost-effective in younger, low risk patients. This simply means we do not need to ROUTINELY do bone densities as part of the well woman exam each year. Please note that I did NOT say NEVER to use this test! In patients with risk factors for thinning bones, bone densities can give us excellent information.
What are risk factors?
--Family history of osteoporosis (Do you have tiny, hunched over, little old ladies for grandparents?)
--Thyroid disease (especially people who have been over-replaced for under active thyroid disease)
--Smoking
--Excessive alcohol intake (>2/day)
--History of a fracture without having trauma
--Age over 65 and Female, or 70 & Male
--Caucasian or Asian
If you have one, or especially, several of these risk factors, your doctor may indeed suggest getting a bone density test, and she should!
BOTTOM LINE: Bone density testing should not be a ROUTINE screen for everyone, but reserved for those with risk factors.
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