The US Preventive Services Task Force (USPSTF) has released a series of draft recommendations on osteoporosis screening in US adults aged 50 years or older.
The USPSTF found convincing evidence that screening with bone mineral testing can detect osteoporosis and that treatment of women with osteoporosis can provide at least a moderate benefit in preventing fractures in women aged 65 years and older as well as postmenopausal women younger than 65 years at increased risk for osteoporosis. The USPSTF found inadequate evidence on the benefits and harms of treating screen-detected osteoporosis to reduce the risk of osteoporotic fractures in men.
The task force found convincing evidence that bone measurement tests are accurate for predicting osteoporotic fractures in both women and men. The most commonly used test is central dual-energy X-ray absorptiometry (DXA) of the hip and lumbar spine. Although several bone measurement tests similarly predict the risk of fracture, DXA directly measures bone mineral density, and most treatment guidelines use central DXA to define osteoporosis and the treatment threshold to prevent osteoporotic fractures. The USPSTF found adequate evidence that clinical risk assessment tools are moderately accurate in identifying the risk of osteoporosis and osteoporotic fractures.
The task force found no studies that described harms of screening for osteoporosis in men or women. Based on the nature of screening with bone measurement tests and the low likelihood of serious harms, the USPSTF found adequate evidence to identify these harms as low risk. Harms associated with screening may include radiation exposure from DXA and opportunity costs, such as time and effort required by the patient.
The updated recommendation statement applies to older adults without a history of low-trauma fracture and without conditions that may cause secondary osteoporosis, such as metabolic bone disease or untreated hyperthyroidism. It does not apply to persons who take long-term medications that may cause secondary osteoporosis, such as glucocorticoids.
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 bone mineral density testing. The USPSTF found there is still insufficient evidence on screening for osteoporosis in men.
Draft Recommendation Statement: Osteoporosis to Prevent Fractures: Screening. US Preventive Services Task Force. November 2017. Available at: https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/osteoporosis-screening1