Recommendations from others
Based on their outcomes model, the US Preventive Services Task Force recommends screening for women aged >65 years, and those aged 60 to 65 years who have risk factors.9 In 1998, the National Osteoporosis Foundation, in collaboration with many other professional organ-izations, recommended bone mineral density test-ing for all women aged >65 years and younger postmenopausal women who have had or are at risk for fractures.10 The 2000 Consensus Development Conference from the National Institutes of Health recommended an individual-ized approach to screening, stating evidence for universal osteoporosis screening is inconclusive.11 The American Association of Clinical Endo-crinologists revised guidelines in 2001 to include screening younger postmenopausal women with a body weight <127 lbs or a family history of nontraumatic spine or hip fracture.12
CLINICAL COMMENTARY
Michael L. Lefevre, MD, MSPH
Department of Family and Community Medicine, University of Missouri–Columbia
The value of screening for osteoporosis is a much bigger issue for clinicians since the pub-lication of the Women’s Health Initiative study and the consequent decline in the number of postmenopausal women using HRT. Evidence for pharmacologic prevention of fractures in women who do not meet conventional criteria for osteoporosis is lacking. Data on fracture risk with osteoporosis are short-term, and the risks and benefits of long-term treatment of women who do have osteoporosis are unknown for all of the treatment options.
The conclusion to focus our screening efforts on women aged 65 years and older, where the near-term benefits seem to clearly outweigh the risks, is certainly clinically prudent. Irrespective of our wishes, many women in their fifties are getting osteoporosis screening at health fairs or shopping malls. Although I do not encourage this age group to be screened, when faced with results showing osteoporosis, I do still treat with a bisphosphonate, based on the trials noted above.