A 60-year-old white woman presents for an office visit. Her mother recently broke her hip, and the patient is concerned about her own risk for osteoporosis. She weighs 165 lb and is 5 ft 6 in tall. She has a 50-pack-year history of tobacco use. Medications include a multivitamin and levothyroxine 50 µg/d. Her exercise regimen includes mowing the lawn and taking care of the garden. She took hormone replacement therapy for 6 years after menopause, which occurred at age 49.
Which recommendation for osteoporosis screening is most appropriate for this patient?
A. Nuclear medicine bone scanAccepted indications for bone mineral density testing include estrogen-deficient women at clinical risk of osteoporosis and all women over age 65. This patient’s risk factors include estrogen deficiency, low calcium intake, family history, and previous tobacco use; therefore peripheral bone densitometry, such as a heel quantitative ultrasound, would not be sufficient. The heel ultrasound, which does predict fracture risk in women over 65, is less accurate than DXA and is useful for population-wide screening programs, not individual treatment recommendations. A nuclear medicine bone scan has no role in the diagnosis of osteoporosis. Quantitative CT allows for adequate prediction of vertebral fractures, but is not considered standard of care at this time, and exposes the patient to greater radiation than DXA.