USPSTF offers updated recommendations for osteoporosis screening
US Preventive Services Task Force, Curry SJ, Krist AH, Owens DK, et al. Screening for osteoporosis to prevent fractures: US Preventive Services Task Force recommendation statement. JAMA. 2018;319:2521-2531.
The 2018 updated osteoporosis screening recommendations from the United States Preventative Services Task Force (USPSTF) may seem contradictory to the conclusions of Gourlay and colleagues discussed above. They are not.
The USPSTF authors point out that by 2020, about 12.3 million US individuals older than 50 years are expected to have osteoporosis. Osteoporotic fractures (especially hip fractures) are associated with limitations in ambulation, chronic pain and disability, loss of independence, and decreased quality of life. In fact, 21% to 30% of people who sustain a hip fracture die within 1 year. As the US population continues to age, the potential preventable burden will likely increase.
_
Evidence on bone measurement tests, risk assessment tools, and drug therapy efficacy
The USPSTF conducted an evidence review on screening for and treatment of osteoporotic fractures in women as well as risk assessment tools. The task force found the evidence convincing that bone measurement tests are accurate for detecting osteoporosis and predicting osteoporotic fractures. In addition, there is adequate evidence that clinical risk assessment tools are moderately accurate in identifying risk of osteoporosis and osteoporotic fractures. Furthermore, there is convincing evidence that drug therapies reduce subsequent fracture rates in postmenopausal women.
The USPSTF recommends the following:
- For women aged 65 and older, screen for osteoporosis with bone measurement testing to prevent osteoporotic fractures.
- For women younger than 65 who are at increased risk for osteoporosis based on formal clinical risk assessment tools, screen for osteoporosis with bone measurement testing to prevent osteoporotic fractures.
WHAT THIS EVIDENCE MEANS FOR PRACTICE
We all agree that women older than 65 years of age should be screened with DXA measurements of bone mass. The USPSTF says that in women under 65, a fracture assessment tool like FRAX, which does not require bone density testing to yield an individual’s absolute 10-year fracture risk, should be used to determine if bone mass measurement by DXA is, in fact, warranted. This recommendation is further supported by the article by Gourlay and colleagues, in which women aged 50 to 64 with subthreshold FRAX scores had a very low risk of fracture prior to age 65.
We all agree that women older than 65 years of age should be screened with DXA measurements of bone mass. The USPSTF says that in women under 65, a fracture assessment tool like FRAX, which does not require bone density testing to yield an individual’s absolute 10-year fracture risk, should be used to determine if bone mass measurement by DXA is, in fact, warranted. This recommendation is further supported by the article by Gourlay and colleagues, in which women aged 50 to 64 with subthreshold FRAX scores had a very low risk of fracture prior to age 65.
Share your thoughts! Send your Letter to the Editor to rbarbieri@mdedge.com. Please include your name and the city and state in which you practice.