Osteoporosis, meaning porous bone is a silent disease related to aging which affects the bones making them porous. According to the National Osteoporosis Foundation, osteoporosis affects approximately 54 million Americans living with the condition.
Some of the sufferers of osteporosis have been known to have a condition known as osteopenia (low bone mass). It is one of the risk factors for osteoporosis. It is an expensive condition requiring more and more medication and care as the patient grows older.
Osteoporosis can also be caused by a variety of disorders including autoimmune and digestive diseases, medical procedures, cancer, neurological disorders, hormonal problems, poor diet, and certain medications, to name a few.
At the moment, the only way to diagnose osteoporosis prior to a fracture is by conducting a bone density test. Early detection of osteoporosis is critical to successful treatment of the disease. Without this, it will be almost impossible to reverse some of its effects and slow the development of painful symptoms.
Here are the most important imaging screening tests to be done to check for osteoporosis in a patient:
To begin with, one easy way to evaluate risk is using an online tool called the FRAX calculator. The FRAX calculator allows you to calculate the chance of having an osteoporotic fracture over the next ten years.
A 65-year-old female with no other risk factors has a 9.3 percent chance of fracture in her next 10 years of life, which is considered a reasonable threshold to use for screening.
By using the FRAX tool, patients and providers can determine which men and women meet this same threshold based on risk factors. For example, a 55-year-old female smoker whose mother had a hip fracture has about a 12 percent chance of fracture in the next 10 years, so she should undergo screening.
There is some debate regarding optimal intervals for repeat screening of men and women, but when repeat testing is performed, comparison is easier if the same type of test is done.
Bone Density Testing
The main examination used for bone density testing is dual X-ray absorptiometry, more commonly referred to as DXA or DEXA. Dual-energy X-ray absorptiometry measures bone mineral density using two X-ray beams, with different energy levels, are aimed at the patient’s bones. When soft tissue absorption is subtracted out, the bone mineral density can be determined from the absorption of each beam by bone
Other tests include an ultrasound of the heel of the foot, and a QCT, a type of CT scan which gathers cross-sectional information.
Different opinions on the importance of screening for men and women. Some authorities support screening men at age 70 and women at 65, but the United States Preventive Services Task Force (USPSTF) does not recommend screening men. Nonetheless, those with risk factors may require screening at an earlier age.
Other Screening Tests
While debates about healthcare policy continue throughout the world, most seem to agree that prevention makes both economic and public health sense. Medical imaging can play an important role in screening for osteoporosis.
Also, apart from bone density testing, experts recommend some other medical imaging screening procedures based on cost-effectiveness and medical-effectiveness criteria. These include tests such as: abdominal aortic ultrasound for aneurysm screening, mammography, and Chest CT for lung cancer screening.
To add to that, the American Cancer Society advocates Breast MRI for breast cancer screening in high risk women – those with a lifetime risk of the disease that exceeds 20 percent. Other medical imaging screening tests that are more controversial include CT colonography to screen for colon cancer, prostate ultrasound for prostate cancer, cardiac calcium scoring coronary artery disease risk assessment, and carotid ultrasound for stroke risk assessment.
Although not traditionally grouped as a medical imaging procedure, retinal screening for diabetic retinopathy is now widely recommended and increasingly performed using medical photography.
Screening and Preventive Care
Knowing the fact that preventive imaging screening is critical in the management of osteoporosis, it becomes even more important for imaging providers to play a more active role in improving care and compliance. By this, screening decisions should not necessarily be left entirely to primary care physicians?
As an imaging provider, in practice, what measures would you take to prevent the development of osteoporosis in an aging patient who shows up with symptoms at your clinic? Please share your thoughts in the comments
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