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Difficulty: EasyPreventive Care and Screening

A 65-year-old woman comes to the ambulatory clinic for a routine health maintenance examination. She has no acute complaints. Her medical history is notable for mild, intermittent lower back pain that is well-controlled with occasional over-the-counter ibuprofen. She went through menopause at age 52. She has never smoked, consumes alcohol occasionally, and walks 30 minutes daily. Vital signs are within normal limits. Physical examination, including a musculoskeletal assessment, shows no abnormalities. Which of the following is the most appropriate next step in management for this patient?

  1. Ordering dual-energy x-ray absorptiometryAnswer
  2. B
    Ordering an abdominal aortic ultrasound
  3. C
    Ordering low-dose computed tomography of the chest
  4. D
    Ordering magnetic resonance imaging of the lumbar spine
  5. E
    Initiating systemic estrogen therapy

Answer

Ordering dual-energy x-ray absorptiometry
The correct answer is ordering dual-energy x-ray absorptiometry. The United States Preventive Services Task Force (USPSTF) recommends screening for osteoporosis with bone measurement testing (such as a DEXA scan) to prevent osteoporotic fractures in all women aged 65 years and older. This patient has reached the age threshold and requires this newly indicated screening.

Step-by-Step Solution

1
Identify the patient's demographic and risk factors
The patient is a 65-year-old female with no history of smoking and no acute or red-flag symptoms.
Age, sex, and smoking history are primary determinants for identifying appropriate preventive screening guidelines.
2
Determine the age-appropriate screening guidelines for this demographic
The USPSTF recommends bone measurement testing to prevent osteoporotic fractures in women aged 65 years and older.
This is a Grade B recommendation intended to identify osteoporosis early and initiate treatment to prevent future fractures.
3
Rule out non-indicated interventions
Abdominal aortic aneurysm and lung cancer screenings are incorrect due to a lack of smoking history and specific sex criteria. Lumbar MRI and systemic estrogen are clinically inappropriate.
Avoiding unnecessary diagnostic tests and harmful treatments is a key component of effective preventive care.

Key Concept

The United States Preventive Services Task Force (USPSTF) recommends screening for osteoporosis with bone measurement testing (e.g., DEXA scan) in all women aged 65 years and older.
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Topics

Preventive Care and Screening

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