North American Menopause Society Recommendations

The North American Menopause Society (NAMS) published a comprehensive review of postmenopausal osteoporosis in the journal Menopause in 2002 (14). Included in the review were recommendations for bone density testing in the specific context of osteoporosis prevention and management. NAMS noted that measurement of BMD is the preferred method for diagnosing osteoporosis and that DXA is the "technological standard" for measuring BMD. NAMS stated that the total hip was the preferred region of interest to evaluate, particularly when measuring bone density in women over 60 because of the increased likelihood of degenerative calcification in the spine that would affect spine measurements.3 Nevertheless, spine measurements were described as useful in early postmenopausal women because of the faster rate of bone loss at that site compared to the rate seen at the proximal femur. Citing a report from the International Osteoporosis Foundation (IOF) published in 2000 (15), NAMS stated that they generally supported the use of the total hip or femoral neck for the diagnosis of osteoporosis rather than other skeletal sites.

The NAMS recommendations, like those of the NOF, ACOG, and AACE included measuring bone density in all women age 65 years and older. They also recommended measuring bone density in postmenopausal women under the age of 65 who had at least one of the following risk factors: a nonspine fracture after menopause, weight less than 127 lb, or a history of a first-degree relative with a spine or hip fracture. NAMS also recommended BMD measurements in premenopausal women who experienced fractures deemed to be low trauma fractures and those with known causes of bone loss. In all cases, testing should only be done if the results would influence treatment decisions.

3 See Chapter 2 for a discussion of the effect of dystrophic calcification on the measurement of BMD in the spine.

Recommendations were also made that dealt with the frequency of repeat testing, depending on the clinical circumstances. In women who were not receiving a pharma-cologic intervention for osteoporosis, NAMS stated that repeat testing should not be performed for 3 to 5 years. In those women who were receiving treatment, repeat testing should not be performed for 2 years. NAMS stated that peripheral sites should not be used to monitor therapy. Instead, they noted that peripheral site measurements should be used only for fracture risk assessments. Diagnosis and monitoring should only be done using the spine or proximal femur.



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