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Evidence-based guidelines needed for osteoporosis screening and treatment.

WHEN A 40-YEAR-OLD WOMAN has an annual examination, she can expect her physician to recommend she begin having regular mammograms. When that same woman reaches age 65, it is far less likely that her physician will advise that she be screened for osteoporosis. Even if a woman has had a fracture, she may not receive treatment. “There is still a big gap out there between what many people think is appropriate and what is actually happening,” said Ethel S. Siris, MD, director of the Toni Stabile Center for the Prevention and Treatment of Osteoporosis at Columbia-Presbyterian Medical Center in New York City. Siris, president-elect of the National Osteoporosis Foundation (NOF), would like to see osteoporosis screening, including bone mineral density measurements or a risk assessment, become part of the standard of care for older women. Siris also is leading the National Osteoporosis Risk Assessment (NORA), a longitudinal observational study of 200 160 postmenopausal women not previously diagnosed with osteoporosis (Siris et al. JAMA. 2001;286:2815-2822). JAMA: Besides bone mineral density measurements, what kind of risk assessment is appropriate for older women? Dr Siris: On your 65 birthday you should automatically be asked, “Have you ever had a fracture, did your mother ever fracture, are you a smoker, what do you weigh, did you take estrogen after menopause?” JAMA: Why aren’t more physicians screening for osteoporosis and treating patients with the disease? Dr Siris: We’ve really only been able to deal with osteoporosis in the past 10 years in an effective manner in terms of having diagnostic tools and an armamentarium of treatments. It seems to be taking time to get the primary care physicians and physicians who treat fractures to learn what we can do and should be doing. Following a fracture