At what age can osteoporosis screening be stopped in elderly women?

When to Stop Osteoporosis Screening in Elderly Women

There is no specific age at which osteoporosis screening should be stopped in elderly women, as current guidelines do not provide an upper age limit for screening. 1

Current Screening Recommendations

• The U.S. Preventive Services Task Force (USPSTF) recommends screening for osteoporosis in women aged 65 years or older 2, 1
• The USPSTF does not specify an upper age limit for screening 2
• The 2002 USPSTF guideline explicitly states: "There are no data to determine the appropriate age to stop screening" 2

Factors to Consider When Deciding to Continue Screening

When considering whether to continue screening in very elderly women, clinicians should evaluate:

1. Life Expectancy: Consider whether the patient's life expectancy is sufficient to benefit from treatment if osteoporosis is detected

2. Fracture Risk: Elderly women have the highest risk of osteoporotic fractures, particularly hip fractures, which are associated with:

   • Significant morbidity and mortality (more than one-third of men who experience hip fractures die within 1 year) 2
   • Loss of independence
   • Decreased quality of life
   • Chronic pain and disability

3. Treatment Benefits: Evidence shows that treatment of osteoporosis can reduce fracture risk even in older patients:

   • Zoledronic acid has been shown to reduce fracture risk in frail patients with recent hip fracture 3
   • Strontium ranelate has documented anti-fracture efficacy for both vertebral and non-vertebral fractures in patients over 80 years 3

4. Monitoring Intervals: For patients already diagnosed with osteoporosis:

   • A minimum of 2 years may be needed to reliably measure changes in bone mineral density 2
   • Longer intervals may be adequate for repeated screening to identify new cases 2
   • The standard monitoring interval for DEXA scanning is 2 years, with shorter intervals (1 year) for high-risk patients 1

Practical Approach

Given the absence of an upper age limit in guidelines, consider this approach:

1. Continue screening in women who:

   • Have reasonable life expectancy (generally >2-3 years)
   • Would be candidates for treatment if osteoporosis is detected
   • Have maintained functional status and quality of life
   • Have not had recent screening within the past 2-5 years

2. Consider discontinuing screening in women who:

   • Have limited life expectancy (<2 years)
   • Have significant comorbidities that would preclude treatment
   • Are already on appropriate treatment for osteoporosis
   • Would not want treatment even if osteoporosis was detected

Common Pitfalls to Avoid

• Underscreening: Despite recommendations, only 57.8% of eligible women aged 65-74 years and 42.7% of women aged ≥75 years receive recommended screening 1
• Assuming age alone is a reason to stop: Age is actually a major risk factor for osteoporosis and fractures, making screening potentially more valuable in the elderly 3
• Overlooking treatment benefits in the elderly: Studies show that even the oldest patients can benefit from osteoporosis treatment 3
• Failing to consider patient preferences: Some elderly patients may prefer not to undergo screening based on their values and goals of care

In conclusion, while guidelines do not specify an upper age limit for osteoporosis screening, clinicians should consider life expectancy, fracture risk, potential benefits of treatment, and patient preferences when deciding whether to continue screening in very elderly women.