Over half of all postmenopausal women will develop a fracture related to osteoporosis during their lifetime, including 15% who will suffer hip fractures. Although fewer men than women develop osteoporosis, more than one-third of men who sustain a hip fracture die within 1 year. A new statement issued by the United States Preventive Services Task Force (USPSTF) aims to provide clinicians with current, evidence-based recommendations for osteoporosis screening. These recommendations, published in the January 2011Annals of Internal Medicine, are designed to assist clinicians on the appropriate time to initiate osteoporosis screening based on patient characteristics and clinical data.
Major Modifications to Osteoporosis Recommendations
In 2002, the USPSTF recommended to routinely screen women aged 65 and older for osteoporosis and screen women between the ages of 60 and 64 with an increased risk for osteoporotic fractures. Since 2002, a wealth of data has emerged on risk among younger women. Accordingly, the new recommendation extended screening for osteoporosis to women aged 65 or older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old Caucasian woman who has no additional risk factors. The current guidelines contain no recommendation for or against osteoporosis screening in younger women.
“Validation studies on tools to predict osteoporosis risk have been completed, and these investigations have revealed that risk assessment tools can accurately identify potential osteoporosis risk.”
In 2002, a single osteoporosis screening tool was not recommended for universal use. Since that time, validation studies on tools to predict osteoporosis risk have been completed, and these investigations have revealed that risk assessment tools can accurately identify potential osteoporosis risk. The World Health Organization Fracture Risk Tool, or FRAX, is one such validated screening assessment that requires little clinical information and is now recommended. The updated guidelines also note that bone mineral density testing should be utilized if women are at increased risk for osteoporosis. It should also be noted that the 2011 USPSTF recommendations for women are congruent with those issued by other organizations, including the National Osteoporosis Foundation.
Concrete Osteoporosis Recommendations Needed for Men
At this time, the available evidence for osteoporosis screening in men is insufficient. The USPSTF is not for or against the screening of osteoporosis in men. However, the National Osteoporosis Foundation recommends screening all men over the age of 70 and high-risk men aged 50 to 69. That said, the USPSTF did not make a recommendation specifically for men because the data are not robust. To improve the ranking of recommendations for men, it is clear that additional research is needed to assess the balance between benefits and harms of osteoporosis screening.
In addition to building the knowledge base on osteoporosis screening in men, it’s also important to establish more specificity around the appropriate interval timing between screenings for all people at risk for the disease. An upper endpoint age is also currently unavailable, per the USPSTF, because the data in this area of research are lacking. Additionally, it behooves researchers to develop a greater understanding of how well these recommendations may translate to special populations. Future studies should aim to include more ethnic and racial minority patients. In the meantime, clinicians can manage patients confidently when utilizing the current USPSTF guidelines in their practice. They should offer women a complete package of effective preventive services, including osteoporosis screening around the time of menopause, to help patients live longer, healthier lives.
Readings & Resources (click to view)
U.S. Preventive Services Task Force. Screening for osteoporosis: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2011 Jan 18 [Epub ahead of print]. Available at:http://www.annals.org/content/early/2011/01/13/0003-4819-154-5-201103010-00307.full.
U.S. Preventive Services Task Force. Screening for osteoporosis in postmenopausal women: recommendations and rationale. Rockville, MD. Agency for Healthcare Research and Quality; 2002.
Nelson HD, Haney E, Dana T, Chou R. Screening for osteoporosis in men and women: systematic evidence update for the U.S. Preventive Services Task Force. Evidence synthesis no. 77. AHRQ Publication No. 10-05145-EF-1. Rockville, MD. Agency for Healthcare Research and Quality; 2010.
Hillier TA, Stone KL, Bauer DC, et al. Evaluating the value of repeat bone mineral density measurement and prediction of fractures in older women: the study of osteoporotic fractures. Arch Intern Med. 2007;167:155-160.