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Postmenopausal women with good bone mineral density at an initial osteoporosis screen can probably wait about 15 years before the next test, researchers suggested.

Based on the amount of time it took for 10% of women 67 and older to progress to osteoporosis, the testing intervals for those with normal bone mineral density and mild osteopenia at the first test were determined to be 16.8 and 17.3 years, respectively, according to Margaret Gourlay, MD, MPH, of the University of North Carolina at Chapel Hill, and colleagues.

Those intervals shortened to 4.7 years for women with moderate osteopenia and 1.1 years for those with advanced osteopenia on initial testing, the group reported in the Jan. 19 issue of the New England Journal of Medicine.

In an interview, Gourlay said that the study can be used as the basis of discussions between women and their doctors about how often osteoporosis screening should be performed after an initial test.

"These results are strong enough that we should be screening women who have good bone density on their first test less often than the women who have lower levels of bone density," she said, pointing to the dramatic difference between the women with normal bone mineral density or mild osteopenia and those with more brittle bones.

Bone mineral density testing with dual-energy x-ray absorptiometry (DXA) to screen for osteoporosis is recommended for all women 65 and older, although there are few data to determine the optimal interval between tests.

Gourlay and colleagues set out to address that uncertainty using data from the Study of Osteoporotic Fractures (SOF). The current analysis included 4,957 women 67 and older who had either normal bone mineral density (T score at the femoral neck and total hip of -1.00 or higher) or osteopenia (T score of -2.49 to -1.01).

The women did not have a history of hip or clinical vertebral fracture and had not been treated for osteoporosis. The researchers followed them for up to 15 years.

The testing interval for the subgroups of women was defined as the time needed for 10% to make the transition to osteoporosis before having a hip or clinical vertebral fracture or receiving osteoporosis treatment.

During follow-up, the percentage of women who developed osteoporosis was 0.8% for those with normal bone mineral density and 4.6%, 20.9%, and 62.3% for those with mild, moderate, and advanced osteopenia.

The estimated testing intervals for the four groups of declining bone mineral density were 16.8, 17.3, 4.7, and 1.1 years, which remained robust after adjustment for major clinical risk factors for fracture.

"However, clinicians may choose to reevaluate patients before our estimated screening intervals if there is evidence of decreased activity or mobility, weight loss, or other risk factors not considered in our analyses," the researchers wrote.

Gourlay said that age and body mass index are the most important factors to consider in addition to bone density.

There was a significant trend that supported shorter testing intervals as women age. For example, the estimated time to transition from moderate osteopenia to osteoporosis was about five years for women age 70 and three years for those age 85.

In addition, if a patient is very thin, it is more likely she will have lower bone density, Gourlay said.

Although Gourlay said the findings could make an impact in the clinic immediately, she and her colleagues acknowledged some limitations, including the lack of information on the potential risks and benefits and cost-effectiveness of screening.

In addition, the analysis included only about half of the SOF participants, all of whom were 67 and older and nearly all of whom were white.

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