New recommendations for osteoporosis screening published by USPSTF
MedWire News: The US Preventive Services Task Force (USPSTF) has recommended that all women aged 65 years and older be routinely screened for osteoporosis.
In an update to its 2002 recommendation, the USPSTF also recommended that younger women (aged 50-64 years) with risk factors for osteoporosis, such as tobacco use, alcohol use, low body mass, and parental history of fractures should be screened if their FRAX 10-year fracture risk is at or above that of a 65-year-old white woman who has no additional risk factors.
Using the FRAX tool, the USPSTF team, chaired by Ned Calonge (The Colorado Trust, Denver, USA), calculated that a 65-year-old white woman with no other risk factors has a 9.3% 10-year risk for any osteoporotic fracture.
"While the USPSTF recommends using a threshold of 9.3% 10-year fracture risk to screen women aged 50 to 64 years, clinicians should also consider each patient's values and preferences and use clinical judgment when discussing screening with women in this age group," the group says.
"Menopausal status is one factor that might affect a decision about screening in this age group," they add.
The USPSTF did not define a specific upper age limit for screening in women because fracture risk continues to increase with age and the harms associated with treatment are small.
However, they note that clinicians should take into account remaining lifespan when deciding whether to screen patients with significant morbidity because treatment benefits may only emerge after 18-24 months.
In contrast to women, the USPSTF found insufficient evidence to make a recommendation for screening men, but said that the potential preventable burden, potential harms, current practice, and cost should be taken into consideration when deciding whether to screen men.
In terms of detecting osteoporosis, the group found convincing evidence that tests such as dual energy X-ray absorptiometry and qualitative ultrasound predict short-term risk for osteoporotic fractures in women, as well as in men.
In spite of this, there was a lack of evidence about optimal intervals for repeated screening. "Because of limitations in the precision of testing, a minimum of 2 years may be needed to reliably measure a change in BMD; however, longer intervals may be necessary to improve fracture risk prediction," they say.
The recommendation statement is published in the Annals of Internal Medicine.
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By Laura Dean