Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 274

The recommendation to screen at least once for patients in all categories except End of Life is based on studies that show inadequate rates of diagnosis and treatment. However, there is no evidence to show that mass screening of elderly women and men for osteoporosis will reduce cost or improve outcomes.⁴⁴

Dual‐energy X‐ray absorptiometry (DXA) is the current gold standard test for diagnosing osteoporosis in people without a known osteoporotic fracture. It is, however, an imperfect test, diagnosing osteoporosis in less than half of people who progressed to have osteoporotic fractures.⁴⁷ The WHO fracture risk algorithm (FRAX) should be used to improve diagnostic accuracy. It predicts a 10‐year probability of fracture in men and women who have clinical risk factors: age, gender, previous fracture, femoral neck bone mineral density, bone mass index, prior corticosteroid use, history of rheumatoid arthritis, parental history of hip fracture, and current history of smoking and alcohol use.^44,45 The osteoporosis self‐assessment screening tool (OST) and the calcaneal ultrasound are both being evaluated to determine their potential role in better diagnosis of osteoporosis. The USPSTF recommends screening women at age 65 and women at age 60 with risk factors for osteoporosis. The frequency of screening and the age at which to stop screening are not known. The ACP recommends screening for men using DXA starting at age 70 (or younger for men with risk factors: low body weight, physical inactivity, chronic glucocorticoid use, previous fragility fracture, and hypogonadism).