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Clinical Guidelines
The World Health Organization
(WHO) has established the following definitions based on bone density
measurement at any skeletal site -
Normal :T-score above -1 (BMD is within 1 SD of a “young normal” adult)
Osteopenia:T-score between -1 and -2.5 (BMD is between 1 and 2.5 SD below that of a “young normal” adult)
Osteoporosis:T-score at or below -2.5 (BMD is 2.5 SD or more below that of a “young normal” adult. Women in this group with one or more fractures are deemed to have severe or “established” osteoporosis.)
Although these definitions are necessary to establish the prevalence of osteoporosis, they should not be used as the sole determinant of treatment decisions.
Since we now have effective therapy to prevent and treat osteoporosis, who should have a B.D. done?
According to the Osteoporosis Society of Canada guidelines and The National Osteoporosis Foundation (NOF), both leading sources of information about osteoporosis and bone measurement, they recommend women have a bone density test if they are:
- 40 years and older, especially in the 65years and older age group
- Postmenopausal - with at least one risk factor besides menopause or with a fracture
- Relevant medical health conditions and long term medication that may exacerbate bone loss e.g. Impaired Renal Function
- Considering osteoporosis therapy
- On prolonged hormone replacement therapy
- X-ray evidence of osteopenia/osteoporotic fracture
- Long term oral glucocorticoid therapy
- Primary hyperparathyroidism
- A strong family history of osteoporosis or other risk factors for osteoporosis
- Ongoing therapy for osteoporosis: to monitor efficacy of therapy
It is important to remember that studies have shown that up to 30% of osteoporosis patients do not have any identifiable risk factors.