How would you assess Elena's osteoporotic fracture risk?

EXPERT OPINION

 

Elena is postmenopausal but still less than 65 years old, the age when a dual-energy x-ray absorptiometry (DXA) is recommended for women without additional risk factors for fracture. She does not have a smoking history or pattern of alcohol consumption that would indicate increased fracture risk. However, several factors suggest possible increased risk for her age. History of Grave’s disease is associated with greater risk of fracture. Maternal history of hip fracture also increases risk. Her own recent fracture was not low-trauma (such as from a simple fall from a standing position), which would raise more concern, but even a fracture due to a higher trauma level is associated with lower bone density and increased risk of subsequent fracture.[i]

 

T2DM itself is also associated with a modest increase in fracture risk, particularly if duration is greater than 10 years.[ii] To be clear, though T2DM increases fracture risk, there are no recommendations from the US Preventive Services Task Force (USPSTF) or other professional societies to screen patients early due T2DM as a risk factor found in isolation. Given Elena's constellation of additional risk factors for fracture beyond gender and age, as well as her concerns regarding osteoporosis, however, DXA scans of the hip and spine would be warranted.[iii]