New U.S. guideline would expand bone density testing

Under a new set of guidelines proposed by an influential U.S. panel, more women would be eligible for bone density tests to detect the bone-thinning disease osteoporosis.

The draft guidelines by the U.S. Preventive Services Task Force (USPSTF), sponsored by the U.S. government's Agency for Healthcare Research and Quality, call for all women to be screened for osteoporosis starting at age 65. Women who are deemed to have higher risks could start earlier, at any age.

The group's last guidelines, in 2002, had the same recommendations for all women 65 and older, but said that high-risk women should not begin screening until age 60. The new draft is based on a review of evidence, published in the Annals of Internal Medicine, since the previous guidelines were issued.

About 10 million people in the U.S. over the age of 50 have osteoporosis, according to the National Institutes of Health, most of them women. More than three times as many women are at risk of the disease.

The disease, which typically begins after menopause, increases the risk of broken bones, the most dangerous of which are broken hips, and may cost the health care system as much as $18 billion per year.

It's unclear how many additional women will now fit the screening criteria, task force chair Dr. Ned Calonge told Reuters Health. "The good news," he said, is that it's the minority of women between 50 and 64 who will be at high risk.

"What physicians should do is not pull out the DXA machine," Calonge said, referring to the device usually used for bone mineral density tests, "but calculate clinical risk factors" in women under 65.

Such scans cost a few hundred dollars each, with DXA machines costing up to $85,000.

Ultrasound, which is cheaper and does not involve radiation, has also been shown to effectively predict fractures, and is also commonly used. However, most diagnostic criteria refer to DXA measurements.

In the new draft, the USPSTF does not recommend testing men for the disease, saying there is not enough evidence to show a benefit. The National Institutes of Health estimates that about 2 million men in the U.S. have osteoporosis, accounting for about one fifth of cases overall.

For women, the draft guidelines are similar to those of the American Congress of Obstetricians and Gynecologists, and also to those of the National Osteoporosis Foundation.

The osteoporosis organization recommends all women be screened starting at age 65, and that doctors use World Health Organization criteria - also used by the USPSTF - to determine if a woman is at higher risk before 65. Such criteria take into account other health conditions, a history of broken bones, and drugs people are taking.

The foundation does, however, recommend that all men be screened starting at the age of 70.