From the Research
For a 72-year-old male with low risk on previous bone mineral density (BMD) testing, a follow-up BMD scan is typically recommended every 5-10 years. This extended interval is appropriate because men with normal BMD or mild osteopenia who don't have major risk factors tend to lose bone mass slowly, as shown in a study published in the Journal of Bone and Mineral Research in 2009 1. If the previous scan showed normal BMD or mild osteopenia without concerning features, and there are no new risk factors such as significant weight loss, new medications affecting bone health (like long-term corticosteroids), or recent fractures, this conservative monitoring approach is reasonable.
Some key points to consider in determining the frequency of BMD tests include:
- The rate of bone loss in low-risk men is typically slow enough that significant changes requiring intervention are unlikely to develop within shorter timeframes, as indicated by a study in JAMA in 2013 2.
- Unnecessary frequent testing adds cost without clinical benefit, as discussed in a review published in Minerva Medica in 2005 3.
- The World Health Organization has established criteria for osteoporosis and osteopenia based on DXA BMD measurements, which are crucial for diagnosing and monitoring osteoporosis, as mentioned in a study published in the Ontario health technology assessment series in 2006 4.
- Recent studies, such as one published in The Journal of Bone and Joint Surgery in 2023 5, highlight the importance of considering clinical risk factors and bone quality in addition to BMD when assessing fracture risk.
However, if any new risk factors develop, such as a fracture, starting medications that affect bone health, or development of conditions that impact bone metabolism (like hyperparathyroidism), earlier repeat testing would be warranted. The rationale for this approach is based on the most recent and highest quality evidence available, prioritizing morbidity, mortality, and quality of life as outcomes.