Osteoporosis Screening and Management in Women Aged 65-85 Years

Screening Recommendations

The U.S. Preventive Services Task Force (USPSTF) strongly recommends screening for osteoporosis in all women aged 65 years or older (Grade B recommendation) 1, 3, 4
Screening should be performed using DXA of the hip and lumbar spine, which is the most widely accepted and validated method for assessing bone mineral density (BMD) 1, 5
Bone density measured at the femoral neck by DXA is the best predictor of hip fracture and is comparable to forearm measurements for predicting fractures at other sites 6
The American College of Physicians recommends that women aged 65 years or older should be screened for osteoporosis using DXA, as this reduces fracture risk and associated morbidity and mortality 1, 2

Assess for additional risk factors that may increase fracture risk, including low body weight (weight < 70 kg) 6
Consider using the FRAX fracture risk assessment tool to estimate 10-year fracture risk 1, 3
The 10-year fracture risk in a 65-year-old white woman without additional risk factors is 9.3% 5

A minimum of 2 years may be needed to reliably measure changes in BMD due to limitations in testing precision 7, 6
Longer intervals may be adequate for repeated screening to identify new cases of osteoporosis 7
The yield of repeated screening will be higher in older women, those with lower BMD at baseline, and those with other risk factors for fracture 7

For patients diagnosed with osteoporosis, the National Osteoporosis Foundation recommends adequate calcium (1000-1200 mg daily) and vitamin D (800-1000 IU daily) intake 9
Consider pharmacological treatment with FDA-approved therapies, such as bisphosphonates (e.g., alendronate), which inhibit osteoclast activity 1, 3, 5
Provide education about minimizing medication side effects and implement fall prevention strategies 5, 9

Not considering race/ethnicity in risk assessment; osteoporosis is common in all racial groups but most common in white women 1, 5
Overlooking the need for patient education about treatment options and their benefits/risks 7
Failing to monitor treatment adherence and effectiveness 9

When prescribing treatments, review the relative benefits and harms of available options to facilitate informed choice 7
For women diagnosed with osteoporosis, schedule annual clinical assessments for treatment adherence, side effects, and new fractures 9