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Invited Commentary
Less Is More
September 2020

The Importance of Careful Patient Selection in the Use of Follow-up Bone Mineral Density Testing

Author Affiliations
  • 1Department of Medicine, University of California, San Francisco
  • 2Department Epidemiology & Biostatistics, University of California, San Francisco
JAMA Intern Med. 2020;180(9):1240-1241. doi:10.1001/jamainternmed.2020.4818

Bone mineral density (BMD) testing of the hip is a remarkably helpful tool to assess the risk of osteoporotic fracture in untreated older men and women. Multiple studies have demonstrated a strong and clinically important relationship between lower hip BMD and higher risk of fracture, and multiple clinical practice guidelines recommend BMD screening using dual-energy x-ray absorptiometry (DXA) for all women older than 65 years, and for postmenopausal women with 1 or more strong risk factors for fracture. Sadly, although in the US more than a 1.5 million DXA examinations are performed annually in women older than 65 years, the proportion of that population that actually receives a screening DXA test remains stubbornly low, ranging from 10% to 35%.1

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