Osteoporosis Screening: A Call for Earlier Action

As a physician, I see far too many patients diagnosed with osteoporosis only after they’ve already suffered significant bone loss. The current U.S. screening guideline—starting at age 65—means we are catching the disease too late for many people. By that point, fractures and decreased mobility have already impacted their lives. We need to shift our focus to earlier screening, especially for those with risk factors, to prevent unnecessary suffering.

Why Are We Waiting Until 65?

Osteoporosis doesn’t develop overnight. It’s a progressive disease that starts years before it’s diagnosed. The problem is that many patients with clear risk factors are not being screened until age 65—when they already have the disease. We should be identifying at-risk individuals much earlier to intervene before irreversible bone loss occurs.

Who Should Be Screened Earlier?

If you have any of the following risk factors, you shouldn’t wait until 65 for screening:

●      Early menopause (average age of menopause is 52 with perimenopause typically happening in a women's mid 40s)

●      Family history of osteoporosis or hip fractures

●      Personal history of fractures

●      History of falls

●      Being a thin women

●      Lower weight or body mass index (BMI <18.8)

●      Poor nutrition, particularly low calcium and vitamin D intake

●      Smoking

●      Inadequate physical activity, especially lack of weight-bearing exercises!

●      Alcohol consumption (more than three drinks per day)

●      Use of certain medications, including corticosteroids or aromatase inhibitors (commonly used in breast cancer treatment)

●      Underlying health conditions, such as early ovarian failure (before age 40), rheumatoid arthritis, chronic liver disease, inflammatory bowel disease, or a history of hyperthyroidism

With many patients we need a more proactive approach

Before we even talk about treatment, we need to start by identifying who is at risk much earlier.  As you can see from above, so many women fall into the category of high risk but are being screened at the typical age of 65. It's no surprise that when a PCP has 15 minutes to talk about all your health screening, new issues and any previous issues, often osteoporosis risk factors are not discussed. At mission metabolic health we have the time to discuss and identify risk factors and order appropriate screening to make sure we find the trends in our patient's bone density early. When early trends are detected, we can intervene and change the trajectory of the disease. In these earlier cases especially, we are often able to focus on lifestyle especially the kind of exercise our patients are doing before we even consider pharmacologic interventions.

Conclusion

Too many patients are being diagnosed with osteoporosis when it’s already too late to prevent significant bone deterioration. If you have risk factors, don’t wait until 65 to take action. Bring this up to your doctors or reach out to us at Mission Metabolic Health you are properly screened. Early screening can be life-changing, preventing fractures, hospitalizations, and a decline in quality of life. This is another important area where sometimes conventional medicine can fall short. If you do have osteoporosis its not to late, there are plenty of tools we can use to help, but like any problem fixing it before it progresses is better.