Osteoporosis

USPSTF Updates Osteoporosis Screening Recommendations

The US Preventive Services Task Force (USPSTF) has updated its 2011 recommendations on screening for osteoporosis.

For the update, they conducted a review of evidence on the screening for and treatment of osteoporotic fractures in men and women, risk assessment tools, screening intervals, and efficacy of screening and treatment within subgroups. Reviewed evidence included studies published since 2011 involving men and postmenopausal women with no known previous osteoporotic fractures and known comorbid conditions or medication use associated with secondary osteoporosis.

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Overall, they found convincing evidence for the effectiveness of bone measurement tests in detecting osteoporosis and predicting osteoporotic fracture and that drug therapies reduce subsequent fracture rates in postmenopausal women, adequate evidence that clinical assessment tools are moderately accurate in identifying osteoporosis risk, and inadequate evidence of the effectiveness of drug therapies in reducing fracture rates in men without previous fractures.

Based on their review, the USPSTF issued the following recommendations:

  • Bone measurement tests, such as central dual-energy x-ray absorptiometry, should be used to screen women aged 65 years and older to prevent osteoporotic fractures (grade B recommendation).
  • Clinicians may first assess clinical risk in younger women who are postmenopausal with tools such as FRAX, SCORE, or OST. Bone measurement tests should then be used to screen those deemed at risk for osteoporosis (B recommendation).
  • There are not enough data to recommend for or against screening men (I statement).

“This recommendation is consistent with the 2011 USPSTF recommendation on screening for osteoporosis. The major change in the current recommendation is that the USPSTF expanded its consideration of evidence related to fracture risk assessment, with or without BMD testing. The USPSTF found there is still insufficient evidence on screening for osteoporosis in men.”

—Michael Potts

Reference:

US Preventive Services Task Force. Screening for osteoporosis to prevent fractures. JAMA. 2018;319(24):2521-2531.