Screening for osteoprosis.

1. Screening for
Osteoporosis
BY/
KHOLOUD MOHAMED
FAMILY MEDICINE RESIDENT

2. Epidemiology:
 Globally, osteoporosis is by far the most common metabolic bone
disease, estimated to affect over 200 million people worldwide. It
affects an estimated 75 million people in Europe, the US, and Japan,
2.2 million in Australia and 70 million in China.
 At age of 50, 50 % of women and 30 - 45 % of men have
osteoporosis, while over 80 of age , 70 % of population have
osteoporosis.

3.  Worldwide, osteoporosis causes more than 8.9 million fractures annually,
resulting in an osteoporosis fracture every 3 seconds. Mortality associated
with osteoporotic fractures ranges from 25 to 30%, a rate similar to breast
cancer and stroke.
 Worldwide, 1 in 3 women over age 50 will experience osteoporosis
fractures, as will 1 in 5 men aged over 50. By 2050, the worldwide
incidence of hip fracture in men is projected to increase by 310% and
240% in women
 The economic burden of osteoporosis-related fracture is significant,
costing approximately $17.9 billion and £4 billion per annum in the USA
and UK, respectively.

5. Screening:
Who should have bone mineral density test (BMD)?
1. All women aged ≥65 years.
2. Men aged ≥70 years and men aged 50-69 based on risk factor profile.
3. Women under 65 years whose fracture risk is ≥9.3% from FRAX analysis.
4. Post-menopausal women of any age with risk factors for osteoporosis.

6. 5. Adults (both women and men) who have a fracture without major trauma
(low-impact/fragility fracture).
6. Adults with significant acquired kyphosis and/or historical height loss >4 cm or
measured height loss greater than 2 cm.
7. Patients undergoing organ transplantation .
8. May be recommended with exogenous (oral) glucocorticoid
9. May be recommended medical conditions and medications associated with an
increased risk of osteoporosis in adults.

7. DEXA scan is a non-invasive test that
measures bone mineral density. DEXA stands
For dual energy x-ray absorptiometry.

8. How to interpret DEXA scan result?
 T-score :This number shows the
amount of bone you have
compared to a young adult of
the same gender with peak bone mass.
 Z-score is used should be used in
premenopausal women, men <50 years, and
in children .

9.  Repeat DEXA scanning frequency will depend upon the clinical situation.
Generally, repeat DEXA should be done no more than every 12-24 months
(ICSI), may consider every 6-12 months in steroid-treated patients or those on
suppressive doses of thyroid hormones. Some common examples:
1. Baseline T scores > -1.0, no new risk factors: repeat in 5 - 10 years.
2. Baseline T scores < -1.0, not on therapy, with ongoing risk factors: repeat in 2-4
years.
3. Baseline T scores < -1.5, monitoring therapy: repeat in 5 years. (ACP)
4. Aggressive disease progression suspected, based on clinical situation: may repeat
in 6-12 months, but this should be fairly uncommon.

10. FRAX®
 WHO fracture risk assessment tool that gives
the 10-year probability of fracture. The output is a 10-year
probability of hip fracture and the 10-year probability of a major
osteoporotic fracture (clinical spine, forearm, hip or shoulder
fracture).
 Used for: postmenopausal women and men over the age of 50.

13. limitations of FRAX :
 Not used for patients on treatment.
 Only hip BMD is considered.
 Risk is assessed in the form of “yes , no “ questions with no
consideration of the dose eg steroids, alcohol .
 Not all risk factors are included eg falls.

17. Thank you