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Question 5#

A 68-year-old Caucasian woman comes to your office for advice regarding her risk factors for developing osteoporosis. She is 5 ft 1 in tall and weighs 105 lb. She stopped having periods at the age of 42 years. She is healthy and walks on a treadmill daily. She does not take any medications. She has never taken hormone replacement therapy (HRT). Her mother died at the age of 71 after she suffered a spontaneous hip fracture. 

The patient asks how and if she should be tested for osteoporosis.

What is the best method to screen her for osteoporosis?

a. Peripheral measurement of her heel with photon absorptiometry
b. Standard x-ray of her spine
c. Dual-energy x-ray absorptiometry (DEXA)
d. Measure biochemical markers of bone remodeling
e. CT scan to measure the bone density

Correct Answer is C

Comment:

DEXA is the best method to measure bone density because it is precise, uses low doses of radiation, and has been well studied in terms of how the DEXA results correlate to risk of fracture. In addition, the World Health Organization (WHO) criteria for diagnosis for osteoporosis and osteopenia are based on DEXA results. CT scan may measure bone density, but requires much higher doses of radiation. Peripheral measurement may correlate to DEXA, but the results are difficult to interpret. X-ray is not used to assess bone density.