Osteoporosis screening by DXA recommended for all men ≥70 and women ≥65 years of age

Osteoporosis screening with dual-energy X-ray absorptiometry (DXA) is recommended for all men ≥70 years of age and all women ≥65 years of age, according to 2024 guidelines of the Osteoporosis Society of Hong Kong (OSHK).

“Hong Kong had seen a 51.2 percent increase in the number of fragility fractures over a 14-year period, from 5,596 cases in 2004 to 8,465 cases in 2018,” said Dr Ching-Lung Cheung, President of OSHK. [Arch Osteoporos 2019;14:104]

According to data from the Hospital Authority, fragility hip fractures had increased from 7,115 cases in 2018 to 7,552 cases in 2023, with about 10 percent of patients experiencing recurrent fragility fracture of the contralateral hip. “Among patients with fragility hip fractures, mortality rate was 13.8 percent at 1 year, 33.8 percent at 3 years, and 49.9 percent at 5 years,” said Cheung. [Hospital Authority Clinical Data Analysis and Reporting System, 2018–2023 data] “Hip fractures are associated with higher mortality than female breast and thyroid cancers and male prostate cancer.” [https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4917461]

The 2024 OSHK Guideline for Clinical Management of Postmenopausal Osteoporosis in Hong Kong recommends universal DXA screening for all men aged ≥70 years and women aged ≥65 years, with earlier screening to be considered if additional risk factors for osteoporosis are present. [Hong Kong Med J 2024;30(Suppl 2):S1-S44]

Based on local cost-effectiveness analysis, the proposed universal DXA screening, along with antiosteoporosis treatment in those with a bone mineral density (BMD)–adjusted FRAX score of ≥3 percent for hip fracture, is estimated to prevent 5,234 hip fractures in Hong Kong over a 10-year period. “This would result in an expected saving of HKD 425 million in terms of direct medical costs,” said Dr Tai-Pang Ip, Chairperson of the OSHK Task Group for the Formulation of the 2024 OSHK Guideline. [Hong Kong Med J 2020;26:227-235]

“We advocate provision of DXA-specific Health Care Voucher for men ≥70 years of age and women ≥65 years of age, to facilitate early identification of high-risk patients,” Ip added.

The 2024 OSHK Guideline also recommends osteoporosis treatment stratification by fracture risk category. Patients at very high risk of fracture (ie, multiple fractures, recent major osteoporotic fracture in ≤24 months, T-score ≤-3.0, fracture on antiresorptive therapy) should be offered anabolic agents as initial treatment, followed by sequential potent antiresorptive drugs, if cost is not a concern. For high-risk patients (ie, age ≥65 years with T-score ≤-2.5, prior fracture in >24 months, FRAX 10-year probability of major osteoporotic fracture ≥20 percent or hip fracture ≥3 percent), potent antiresorptive drugs should be considered. For those at relatively low risk (ie, age <65 years with T-score ≤-2.5 and no prior fracture), a mild antiresorptive drug can be started. [Hong Kong Med J 2024;30(Suppl 2):S1-S44]

“Treatment review should be in place every 1–2 years to optimize outcomes,” suggested Ip.