No systematic bone density test, pleads a committee of experts

Osteoporosis Canada recommends that women and men 65 years of age and older undergo bone mineral density testing to measure their bone mineral density, a risk factor for fragility fractures. The Canadian Task Force on Preventive Health Care (CTTPHC) believes that this test should not be routine in women in this age category and advises against it in men.

The GECSSP — an independent committee of experts created and supported by the Public Health Agency of Canada — has just issued its recommendations concerning preventive screening for fragility fractures in an article published Monday in the Canadian Medical Association Journal.

The Task Force, which has reviewed the scientific literature on this subject, believes that women aged 65 and over should instead use the FRAX assessment tool to assess their risk of fragility fractures (hip, spine vertebral, wrist, etc.), even before considering a bone densitometry.

The FRAX method measures the probability of fractures over 10 years based on various risk factors such as age, weight, height, history of fracture, smoking and taking cortisone for more than three months.

“We think that, if we apply our recommendation, we will greatly reduce the number of bone densitometry tests in Canada without harming anyone,” says Dr.^D Guylène Thériault, chair of the CTFPHC fragility fractures working group. “And, above all, we will inform women of their risks. »

According to the D^D Thériault, a risk of fragility fracture of 35 or 40% over ten years deserves medication. “But if it is 22 or 23%, it is worth having this discussion with the patient, she judges. There are women who will say “yes, I’m interested”, others won’t. Studies have shown that the acceptability of this treatment varies greatly from patient to patient, she says.

If the patient is open to medication, the doctor should order a bone densitometry, then reassess her risk of fracture before deciding on treatment, advises the CTFPHC.

We think that, if we apply our recommendation, we will greatly reduce the number of bone densitometry tests in Canada without harming anyone.

No screening for men

The Task Force does not recommend screening men (regardless of age) and women under 65 years of age. “There’s only one study on screening in men and it didn’t show benefit,” says Dr.^D Theriault. As for women under 65, the single randomized study did not show benefit, she adds.

“For women over the age of 65, credible data indicate that screening and preventive treatment are likely to reduce the risk of these fractures,” said Dr.^D Theriault. Fragility fractures can greatly reduce an older person’s quality of life. »

Often linked to a fall, these fractures can lead to chronic pain, hospitalizations, disability, long-term care in institutions and even premature death, recalls the GECSSP.

Contacted by The duty regarding its current recommendations (issued in 2010), Osteoporosis Canada indicates that it will publish “new clinical practice guidelines later this year”.

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