New Evidence About Osteoporosis Screening in Women - NEJM

Take home message from this study: Older women with BMD testing T scores greater than −1.50 have a low likelihood to develop osteoporosis and can defer retesting for 15 years, researchers concluded.

Women 65 and older are recommended to have bone mineral density (BMD) testing to screen for osteoporosis., but the evidence on appropriate intervals between testing is lacking.

This study followed 4957 women, 67 years of age or older, with normal BMD (T score at the femoral neck and total hip, −1.00 or higher) or osteopenia (T score, −1.01 to −2.49) and with no history of hip or clinical vertebral fracture or of treatment for osteoporosis, prospectively for up to 15 years.

The BMD testing interval was defined as the estimated time for 10% of women to make the transition to osteoporosis before having a hip or clinical vertebral fracture, with adjustment for estrogen use and clinical risk factors. Transitions from normal BMD and from three subgroups of osteopenia (mild, moderate, and advanced) were analyzed with the use of parametric cumulative incidence models.

The estimated BMD testing interval was 16.8 years (95% confidence interval [CI], 11.5 to 24.6) for women with normal BMD, 17.3 years (95% CI, 13.9 to 21.5) for women with mild osteopenia, 4.7 years (95% CI, 4.2 to 5.2) for women with moderate osteopenia, and 1.1 years (95% CI, 1.0 to 1.3) for women with advanced osteopenia.

Bottom line suggested by this study:
Osteoporosis would develop in less than 10% of older, postmenopausal women during rescreening intervals of approximately 15 years for women with normal bone density or mild osteopenia, 5 years for women with moderate osteopenia, and 1 year for women with advanced osteopenia.

Reference: http://www.nejm.org/doi/pdf/10.1056/NEJMoa1107142

ACOG Cervical Cancer Screening Guidelines

Under Age 21
- ACOG doesn't recommend pelvic examinations for girls < 21 unless they have been sexually active or have a medical complaint such as pelvic pain, vaginitis or irregular menstrual periods
- If a younger girl is sexually active, ACOG recommends a pelvic exam, Pap smear, and STD testing (including for chlamydia and gonorrhea) within three years following first intercourse

- All women between ages 19 and 64 who are sexually active should be tested for human immunodeficiency virus (HIV)

Age 21 to 30
- Pelvic examinations with Pap smears should begin at age 21 for women who have not been sexually active
- Thereafter, annual screening should continue up to age 30 (given higher risk for HPV in this group)
- Screen sexually active women 25 and under for chlamydia.  Urine based testing is adequate.

Over 30
- Screening can be cut back to every two or three years whenever a woman has three consecutive test results that were normal (provided she has no conditions that affect the immune system, was not exposed to the drug diethylstilbestrol (DES) while in utero (before birth), and has no other medical problems that require annual or semi-annual examinations)
- Routine physical pelvic exams should continue annually.

65 and Older
- Although routine pelvic exams should continue after age 65, under certain conditions, Pap smears can be discontinued at this point
- If three consecutive Pap smears are normal and there have been no abnormal results during the previous 10 years (with no history of cervical cancer, HIV or other conditions that affect the immune system, is at no risk of acquiring STDs, and was not exposed to DES) Pap smears can be eliminated from the annual exam

Exceptions
If a woman of any age has a complete hysterectomy for reasons other than cancer and has never had cervical cancer or abnormal Pap smears, Pap testing may be eliminated from routine pelvic exams, according to ACOG guidelines.