What criteria are used to determine who should be treated for low bone density?
DXA is the best test for monitoring changes in BMD in the elderly population. Clinical practice guidelines recommend bone density screening to identify osteoporosis in all women aged ≥ 65 years and in men aged ≥ 70 years. Earlier bone density screening and/or vertebral imaging is recommended for adults at age 50 years with clinical risk factors for fracture (see below). T-scores between −1.0 and +1.0 indicate normal bone density, whereas T-scores between −1.0 and −2.5 indicate low bone mass or osteopenia. T-scores of ≤ −2.5 indicate osteoporosis. Pharmacotherapy for low BMD is not only reserved for those with osteoporosis by DXA criteria. In 2008, the University of Sheffield launched the FRAX tool, which can be used to evaluate the fracture risk in individuals aged 40 to 90 years. The FRAX algorithm calculates an individual’s 10-year probability of major osteoporotic and hip fractures, and can identify those patients who could benefit from treatment. The FRAX tool may be used with or without a screening BMD measurement and takes into account several criteria, including race/ethnicity, age, gender, personal history (and family history) of fracture, current smoking, alcohol use, glucocorticoid use, and having a disorder or chronic disease associated with osteoporosis. A U.S. Food and Drug Administration (FDA)–approved medical therapy should be considered in postmenopausal women and men aged ≥ 50 years if they have (1) a hip or vertebral (clinical or morphometric) fracture; (2) a T-score ≤ −2.5 at the femoral neck or spine (excluding secondary causes); and/or (3) a T-score < −1.0 but > −2.5 at the femoral neck or spine and a 10-year probability of ≥ 20% for a major osteoporosis-related fracture or ≥ 3% for a hip fracture. Additionally, clinical judgment and/or patient preference should be considered for patients with T-scores or 10-year fracture probabilities outside of these values.