The U.S. Preventive Services Task Force (USPSTF) recommends osteoporosis screening for women younger than 65 years whose 10-year predicted risk of major osteoporotic fracture is 9.3% or greater. For identifying screening candidates among women between the ages of 50 to 65 years, however, it is uncertain how the USPSTF strategy compares with the Osteoporosis Self-Assessment Tool (OST) and the Simple Calculated Osteoporosis Risk Estimate (SCORE).
Carolyn Crandall, MD, Professor of Medicine in the Division of General Internal Medicine and Health Services Research at the David Geffen School of Medicine at UCLA, and colleagues examined data from 1994 to 2012 from 5,165 Women’s Health Initiative participants ages 50 to 64 years. Their findings were published in the January 2014 issue of the Journal of Bone and Mineral Research. According to the researchers, the USPSTF strategy would identify only 34% of women who actually had bone mineral density in the osteoporosis range.
For the USPSTF (FRAX major fracture risk ≥ 9.3% calculated without bone mineral density), the OST (score < 2), and SCORE (score > 7) strategies, the researchers assessed sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) to discriminate between those with and without femoral neck T-scores of -2.5 or less. Sensitivity, specificity, and AUC for identifying femoral neck T-scores of -2.5 or less were 34.1%, 85.8%, and 0.60 for USPSTF (FRAX); 79.8%, 66.3%, and 0.73 for OST; and 74%, 70.8%, and 0.72 for SCORE.
“The USPSTF strategy identified about one-third of women ages 50 to 64 years with femoral neck T-scores of -2.5 or less,” the researchers wrote. “Among women ages 50 to 64 years, the USPSTF strategy was modestly better than chance alone and inferior to conventional SCORE and OST strategies in discriminating between women with and without femoral neck T-scores of -2.5 or less.” As a result, the researchers said, following the USPSTF strategy may lead to missed opportunities to decrease fracture risk in at-risk women.
Crandall CJ, Larson J, Gourlay ML, et al. Osteoporosis screening in postmenopausal women 50–64 years old: comparison of U.S. Preventive Services Task Force strategy and two traditional strategies in the Women’s Health Initiative. J Bone Miner Res. 2014; Jan 16 [epub ahead of print].