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Internal Medicine

Answer 3
  1. DEXA scan. The USPSTF currently recommends that women aged 65 years and older receive routine screening for osteoporosis with DEXA scan.4 Although this patient does not meet the age requirement for screening, her low body weight of 112 lb indicates that she is at increased risk for osteoporosis and thus she should undergo a DEXA scan. Lower body weight (< 70 kg [∼ 154 lb]) is the single best predictor of low bone mineral density,5,6 with less evidence to support screening in patients aged younger than 65 years with risk factors such as smoking, family history of osteoporosis, decreased physical activity, alcohol or caffeine use, or low vitamin D or calcium intake. There are currently no guidelines for or against screening for osteoporosis in women aged younger than 60 years or in women aged 60 to 64 years not at increased risk for osteoporotic fractures.4 As mentioned previously, screening for AAA with abdominal ultrasound in women is not recommended. The USPSTF recommends against routine screening for ovarian cancer with transvaginal ultrasound or screening for peripheral arterial disease using the ankle brachial index.

    4. US Preventive Services Task Force (USPSTF). Recommendations and rationale: screening for osteoporosis in postmenopausal women. Available at www.ahrq.gov/clinic/3rduspstf/osteoporosis/osteorr.htm. Accessed 11 Apr 2008.

    5. Cadarette SM, Jaglal SB, Kreiger N, et al. Development and validation of the Osteoporosis Risk Assessment Instrument to facilitate selection of women for bone densitometry. CMAJ 2000;162:1289-94.

    6. Cadarette SM, Jaglal SB, Murray TM, et al. Evaluation of decision rules for referring women for bone densitometry by dual-energy x-ray absorptiometry. JAMA 2001;286:57-63.

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