How to set up a program in osteoporosis screening

March 20, 2006

Use of certain medications (e.g., corticosteroids, medroxyprogesterone, heparin, excess thyroid replacement, certain breast cancer drugs, and older antiepileptic drugs, such as phenytoin)

About 10 million Americans have osteoporosis, and another 34 million or so are at risk for the disease, according to the U.S. Preventive Services Task Force (USPSTF). Untreated, osteoporosis can lead to fractures, disability, and deformity, and, in severe cases, even death. Osteoporosis is relatively easy to prevent. With proper screening, people can find out if they are at risk and take steps to avert the disease.

There are a number of methods to assess bone mineral density (BMD) for bone loss. Dual-energy X-ray absorptiometry (DXA) at the femoral neck is the best predictor of hip fracture, while forearm measurements are equally good at predicting fractures at other locations, according to USPSTF. Other methods of measuring bone density include ultrasound.

The USPSTF recommends that all women aged 65 years and older be screened for osteoporosis, and that women at increased risk for osteoporosis begin screening at age 60. But one should not wait until age 60. The staff at Dakota Pharmacy and Wellness in Bismarck, N.D., perform the majority of screenings on young people to get base readings and assess future risk, said Kevin Oberlander, R.Ph. Younger people are better positioned to head off osteoporosis with lifestyle changes and calcium supplementation.

Do the research. "Do your homework before you start any patient care project," advised Beverly Schaefer, R.Ph., co-owner of Katterman's Sand Point Pharmacy in Seattle. She and her partner, Steve Cone, R.Ph., began offering osteoporosis screening in 1997. "We were one of the first pharmacies in the country to offer it," she said.

Evaluate various programs and decide which aspects to incorporate into your pharmacy's program. Research available screening machines and choose the most appropriate one for you. Most of the manufacturers offer training. Pharmacists simply need access to a device; it can be rented, borrowed, or leased, said Schaefer. She and Cone rent their machine to other pharmacies for $300 a day.

The educational materials patients receive will help them understand osteoporosis and what steps they can take to prevent it. "One of the most important things we identified was not just giving patients [BMD] numbers," said Oberlander. BMD numbers mean nothing to people without education. In addition, he said, "educate yourself on the disease, not only from a pharmaceutical perspective but for lifestyle changes."