Wednesday, April 18, 2012

Bone Densities- Really Necessary?

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)
--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.

No comments: