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The American College of Obstetricians and Gynecologists (ACOG) recently issued guidelines for the clinical management of osteoporosis in women, including recommendations for screening, prevention, and treatment of this condition. The guidelines appeared in the January 2004 issue of Obstetrics and Gynecology.
Approximately 13 to 18 percent of women in the United States who are at least 50 years old have osteoporosis and an additional 37 to 50 percent have osteopenia. Risk factors for osteoporotic fractures in this population include a family history of osteoporosis, previous fractures, white race, dementia, poor nutrition, cigarette smoking, alcoholism, low weight and body mass index, estrogen deficiency, early menopause (before 45 years of age) or prolonged premenopausal amenorrhea, long-term low calorie intake, impaired eyesight despite adequate correction, history of falls, and inadequate physical activity. Appropriate screening strategies and significant pharmacologic interventions are available to prevent and treat osteoporosis.
According to ACOG, the preferred method for diagnosing osteoporosis is bone mineral density testing. Dual-energy x-ray absorptiometry (DEXA) is the technical standard for measuring bone mineral density because it measures at important sites of osteoporotic fractures, has high precision and accuracy, is relatively inexpensive, and has modest radiation exposure.
Clinical Considerations and Recommendations
When should screening for osteoporosis be initiated? These guidelines recommend that testing of bone mineral density be performed based on the patient's risk factors and is not indicated unless the results will affect a treatment or regimen program. Specifically, testing for bone mineral density should be recommended for all women who are postmenopausal and at least 65 years of age. Bone mineral density testing may be recommended for women who are postmenopausal and younger than 65 years who have at least one risk factor for osteoporosis. Finally, bone mineral density testing should be performed on all women...