# Elderly Women with Normal Bone Mineral Density or Mild Osteopenia Appear to Have Low Risk of Progression to Osteoporosis or Hip Fracture Over 15 Years

 

 

      DynaMed Weekly Update - Volume 7, Issue 4 

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Bone density testing is recommended in healthy women ≥ 65 years old to screen for osteoporosis ([National Osteoporosis Foundation 2010 PDF](http://www.nof.org/sites/default/files/pdfs/NOF_ClinicianGuide2009_v7.pdf), [Ann Intern Med 2011 Mar 1;154(5):356](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list%5Fuids=21242341&holding=caugamlib)), but data to determine the optimal interval between screens have been lacking. A recent cohort study followed 4,957 women with normal bone mineral density (BMD) or osteopenia by dual-energy x-ray absorptiometry for up to 15 years. All women were ≥ 67 years old at baseline. Women with a history of hip or clinical vertebral fracture or osteoporosis were excluded.

Women were stratified by baseline BMD for analysis. Osteoporosis developed in 0.8% of women with normal BMD, in 4.6% with mild osteopenia, in 20.9% with moderate osteopenia, and in 62.3% with advanced osteopenia. Hip fracture or clinical vertebral fracture occurred in 2.4% of the whole cohort prior to diagnosis of osteoporosis by BMD.

Based on these data, the authors estimated the time interval for each group over which osteoporosis would develop in 10% of the women before they suffered a hip fracture or clinical vertebral fracture. The intervals were 16-18 years for women with normal BMD or mild osteopenia, about 5 years for moderate osteopenia, and 1 year for advanced osteopenia. They also assessed the time intervals for 2% of women to have a hip or vertebral fracture before the development of osteoporosis. These times were estimated at > 15 years for normal BMD or mild osteopenia and about 5 years for moderate or advanced osteopenia ([level 2 \[mid-level\] evidence](http://www.epnet.com/dynamed/levels.php)) ([N Engl J Med 2012 Jan 19;366(3):225](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=22256806)). While this study cannot determine the optimal interval between screening BMD tests, it may help inform the discussion between clinicians and patients.

For more information, see the [Osteoporosis](http://search.ebscohost.com/login.aspx?direct=true&db=dme&AN=113815&site=dynamed-live&scope=site) topic in DynaMed.