A 55-year-old woman comes to the office for a preventive visit. She has been feeling well but is concerned about osteoporosis because her older friend had a hip fracture last year and now must use a walker. The patient has no medical problems and never has had a fracture or surgery. Menopause occurred at age 50. She has never smoked and drinks alcohol occasionally. Her parents and siblings have had no osteoporotic fractures. Height is 165 cm (5 ft 5 in), weight is 84 kg (185 lb) and BMI is 31 kg/m². The remainder of the physical examination is normal. The patient is instructed to initiate a weight-bearing exercise regimen. Which of the following is the most appropriate osteoporosis screening test for this patient?

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11ec25c8_d2c1_19a8_bc81_1917b64e365e_MD0003_00 Other than timely menopause, this patient has no risk factors for osteoporotic fractures and is at average risk for osteoporosis. Such patients should be screened using dual-energy x-ray absorptiometry (DXA) at age 65, as recommended by the United States Preventive Services Task Force. DXA is the preferred screening test for osteoporosis. It uses scattering of x-ray by bone to measure 2-dimensional density (in g/cm²). The result is reported as a T-score, which is the standard deviations above/below the mean for a healthy young adult at peak bone density; by convention, osteoporosis is a T-score ≤-2.5, whereas osteopenia is a T-score between -1 and -2.5. ² If the patient has multiple risk factors for osteoporosis (eg, weight <58 kg [127 lb], smoking, parental history of hip fracture, early menopause), then the risk should be estimated using the FRAX fracture risk assessment tool. If the risk is high enough, then osteoporosis screening at an earlier age may be appropriate (Choices A and C). FRAX fracture risk assessment tool (Choices D, E, and F) Skeletal survey is a plain x-ray of the entire skeleton, and is typically used in adults to evaluate nonlocalized bone disease (eg, multiple myeloma, disseminated infection). Although skeletal survey may detect osteoporotic fractures and can sometimes detect severe osteoporotic bone loss, it is nonquantitative and has low sensitivity for osteoporosis; DXA is the preferred screening test. Educational objective: Screening for osteoporosis with dual-energy x-ray absorptiometry is recommended in all women age >65 and for younger women with an equivalent risk of osteoporotic fracture. > References: Screening for osteoporosis to prevent fractures: US Preventive Services Task Force Recommendation Statement. (http://www.ncbi.nlm.nih.gov/pubmed/29946735)

A 55-Year-Old Woman Comes to the Office for a Preventive