DXA is inexpensive and safe, but mass screening of people for diagnosing osteoporosis is, nevertheless, impractical. Patients that should be tested include patients on daily prednisone, or those women at the time of menapause who are considering whether or not to use hormone replacement therapy (HRT). Additional patients who should be tested are those who demonstrate signs of possible osteopenia on xrays or compression fractures of uncertain etiology , or those people with several risk factors (3 or more).
The importance of diagnosing osteoporosis lies in the fact that there are now several highly effective treatment modalities available. Estrogen replacement for prevention of postmenopausal bone loss works by alleviating estrogen deficiency. Therapy results in decreased bone turnover and the inhibition of osteoclast activity, as well as leading to increased calcium absorption from the gut and decreased urinary calcium loss.
Estrogen replacement has been shown to reduce the occurrence of fractures by about 50%. The preferred dosage is 0.625 mg a day, and a progestational agent is recommended if the uterus in intact. HRT is not without controversy, however, as it significantly increases the risk of uterine cancer, as well as possibly increases the risk of breast cancer (figure 9). On the
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