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USPSTF 2018 recommends screening to prevent osteoporotic fractures in women 65 years and older (B recommendation)
Clinical Question
Should primary care clinicians recommend screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in postmenopausal women and, if so, at what age?
Bottom line
In this updated 2018 review, the U.S. Preventive Services Task Force (USPSTF) recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in postmenopausal women 65 years and older (B recommendation). The USPSTF also recommends screening for osteoporosis in postmenopausal women younger than 65 years at increased risk of osteoporosis according to a clinical risk assessment tool (B recommendation). Current evidence is insufficient to recommend screening for osteoporosis in men (I statement). These recommendations are consistent with the 2011 USPSTF recommendations on screening for osteoporosis. 2c
Reference
Study design: Systematic review
Funding: Government
Setting: Various (meta-analysis)
Synopsis
In this updated 2018 version, the task force found one randomized trial that compared screening with no screening and found no significant difference in the primary outcome of any osteoporotic fracture. Similarly, no differences were found in secondary outcomes, including incidence of all clinical fractures or mortality. However, there was a significant reduction in hip fracture incidence. There is convincing evidence that various bone measurement tests are accurate for detecting osteoporosis and predicting fractures. In addition, existing clinical risk assessment tools, such as the FRAX tool, among others, are accurate for identifying individuals at increased risk of osteoporotic fractures. Pharmacologic treatment is effective for reducing the risk of subsequent fractures in postmenopausal women. No evidence was found of significant harm from screening, including increased anxiety or decreased quality of life. The American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the National Osteoporosis Foundation similarly recommend bone mineral density testing in postmenopausal women beginning at age 65 years in all women and selectively in postmenopausal women younger than age 65 years with significant risk factors.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
Confirms my practice.
Measurements and the FRAX are suitable for gauging accurately fractures. These apply more specifically to vertebral and hip fractures. While in most controlled trials for treatment and/or prevention of osteoporosis the evidence is strong both statistically and as well is clinically very meaningful, it is less so for other fractures. However, there is a numeric difference in the fractures seen with treatment. Therefore, measurements are only useful if they are followed by preventive therapies: both exercise and drugs. Best is, of course the prevention with adequate intake of Vit D and Calcium.
I wonder what the genetic contribution is to osteoporosis. With the multiplicity of therapies these days, this element appears not be noted as frequently any longer.
Women’s hip fractures are costly to women and to Medicare. The question is, will the Government pay for this testing?
What I would like to know, is how many woman years of treatment it took to prevent one hip fracture. Does treatment make a significant difference in the incidence of hip fracture?
Good poem
Great information