From the Guidelines
Bone Density Monitoring Recommendations Bone density typically starts to decrease in women around the age of 30, and in men around the age of 40, but the rate of decline accelerates after menopause in women, typically around age 50-55 1.
When to Start Monitoring Bone Density
It is generally recommended to start monitoring bone density with a dual-energy X-ray absorptiometry (DXA) scan at age 65 for men and women, or earlier if there are risk factors such as a family history of osteoporosis, low body weight, or a history of fractures 1.
- Consider DXA in all women at the age ≥ 65 years, men age > 70 years, and women and men age ≥ 50 years with risk factors for osteoporosis 1.
- Evaluate for prevalent vertebral fractures with VFA or standard radiography in patients ≥ 50 years with specific risk factors, or with a T-score < -1.0 in older men and women, historical height loss > 4 cm, self-reported but undocumented vertebral fracture, or long-term glucocorticoid therapy 1.
When to Stop Bone Density Medications
It is recommended to stop bone density medications if the patient has been on therapy for 5-10 years, has a low risk of fracture, and has shown improvement in bone density 1.
- However, treatment should be individualized, and the decision to stop therapy should be made in consultation with a healthcare provider.
- The strongest evidence of benefit from antiresorptive drugs is for treatment with denosumab at the osteoporosis dose of 60 mg every 6 months, which has been demonstrated to reduce the risk of fracture 1.
- When denosumab is discontinued, there may be an increase in the risk of vertebral fractures, and the European Calcified Tissue Society suggests the use of a bisphosphonate to reduce this risk upon stopping denosumab 1.
Follow-up Recommendations
- Follow-up DXA as indicated, depending on clinical circumstances 1.
- The frequency of BMD testing in clinical practice may be influenced by the patient’s clinical state, national clinical guidelines, cost and reimbursement 1.
- Suggested intervals between BMD testing are typically 1–5 years after starting or changing therapy 1.
- For patients receiving endocrine treatment for breast cancer, regular follow-up is recommended: every 3–4 months for the first 2 years following treatment, then every 6 months in years 3–5, and annually thereafter 1.
From the Research
Bone Mineral Density Measurements
- Bone mineral density (BMD) measurements are crucial for assessing the risk of fractures and osteoporosis in individuals, particularly in postmenopausal women 2.
- The timing of BMD measurements depends on various factors, including age, menopausal status, and risk factors for osteoporosis.
Age-Related Changes in BMD
- Studies have shown that BMD declines with age in both men and women, with the most significant decline occurring in women after menopause 3, 4.
- In women, BMD loss accelerates substantially in the late perimenopause and continues at a similar pace in the first postmenopausal years 5.
- In men, BMD loss occurs at a slower rate, with a small longitudinal bone loss in the hip throughout life and a small bone loss in the distal forearm after the age of 50 years 3.
Factors Associated with BMD
- Lean mass is the most important determinant of BMD in all age groups in both sexes 4.
- Physical activity, ionized calcium, C-terminal telopeptide (CTX), serum sodium, free estradiol, and smoking are also associated with BMD, but to a varying degree in men and women 4.
- Body weight is a major determinant of the rate of menopausal BMD loss, whereas ethnicity is not a significant factor 5.
Screening and Prevention
- Osteoporosis screening and prevention programs should be targeted to individuals in the 35-50 year age group, as osteopenia can lead to osteoporosis 6.
- Regular BMD measurements can help identify individuals at risk of osteoporosis and fractures, allowing for early intervention and prevention strategies 2, 6.