The U.S. Preventive Services Task Force (USPSTF) is a group of experts that makes recommendations to the U.S. Department of Health and Human Services on policies to prevent diseases. The USPSTF recommendations include guidelines on how best to use screening tests, such as osteoporosis tests, to meet the health needs of people in the United States. The USPSTF recently issued new guidelines for osteoporosis screening. The new guidelines are based on a thorough review of research on the benefits of osteoporosis screening at different ages. The new guidelines recommend that a larger group of women be screened for osteoporosis.
Bone strength is a delicate balance between the body building bone, which strengthens bones, and breaking down bones, which helps keep blood calcium levels normal. The hormone estrogen plays an important role in this balance. When estrogen levels drop during and after menopause this balance can be upset, which can make bones weaker over time. So osteoporosis screening has been recommended for all women older than 65. Still, other factors can increase the risk osteoporosis will develop at a younger age:
- being underweight -- a low body mass index (BMI)
- regularly drinking alcohol
- family history of broken bones because of osteoporosis
Some breast cancer treatments also can cause early bone loss and contribute to osteoporosis:
- aromatase inhibitors (a hormonal therapy)
- removal of the ovaries or shutting them down with medicine
Weak bones can be seen on an x-ray and measured by a bone mineral density (BMD) test. When bone density is below a certain level, osteoporosis is diagnosed. Osteoporosis increases the risk of breaking a bone -- either spontaneously or from a fall.
The new USPSTF guidelines recommend that these women be screened for osteoporosis with a BMD test:
- All women 65 and older, whether or not they're at increased risk for osteoporosis-related fractures.
- Younger women whose risk for osteoporosis-related fractures is similar to the risk of 65-year-old (or older) women and who don't have any osteoporosis risk factors. (Women older than 65 have about a 9% risk of an osteoporosis-related bone fracture within 10 years, so any younger woman with this same 10-year risk should be screened based on the new guidelines.)
- This could include women who are underweight, who smoke or drink regularly, and/or who have a first-degree relative (mother, sister) who had an osteoporosis-related bone fracture.
The USPSTF didn't specifically recommend how frequently women should have BMD screening. Many doctors order this screening test every several years after screening starts.
A number of medicines can strengthen bones and reduce the risk of broken bones in women at risk for osteoporosis, women with early signs of bone weakening, and/or women who've been diagnosed with osteoporosis.
Bisphosphonates are one group of bone-strengthening medicines:
- Actonel (chemical name: risedronate)
- Boniva (chemical name: ibandronate)
- Fosamax (chemical name: alendronate)
- Reclast (chemical name: zoledronic acid)
Reclast is given intravenously once a year. The others are pills taken by mouth.
Selective estrogen receptor modulators (SERMs) are another group of bone-strengthening medicines:
- Evista (chemical name: raloxifene) is used to treat osteoporosis and to reduce the risk of breast cancer in women diagnosed with osteoporosis
- tamoxifen also is a SERM; although it can strengthen bones it's usually used only to reduce the risk of and treat breast cancer
Evista and tamoxifen are pills taken by mouth.
A new osteoporosis treatment called Prolia (chemical name: denosumab) recently was approved by the U.S. Food and Drug Administration (FDA) to treat post-menopausal women diagnosed with osteoporosis who are at high risk of breaking a bone or who can't take or haven't gotten any benefits from other osteoporosis treatments. Prolia is given as an injection under the skin once every 6 months.
The Breastcancer.org Bone Health section has detailed information on bone health, how bone health is measured, and how breast cancer treatments can affect bone health, as well as tips to keep your bones as strong as they can be.