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Osteoporosis to Prevent Fractures, Screening, 2018

* Indicates an old grade definition


Recommendations: Screening for Osteoporosis to Prevent Fractures

  • Osteoporosis to Prevent Fractures:Screening -- Women 65 and Older
    Grade: B
    Specific Recommendations:

      The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 years and older.


  • Osteoporosis to Prevent Fractures: Screening -- Postmenopausal women younger than 65 years at increased risk of osteoporosis
    Grade: B
    Specific Recommendations:

      The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in postmenopausal women younger than 65 years who are at increased risk of osteoporosis, as determined by a formal clinical risk assessment tool.

       

      See the Clinical Considerations section for information on risk assessment.


  • Osteoporosis to Prevent Fractures: Screening --Men
    Grade: I
    Specific Recommendations:

      The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures in men.

       

      See the Clinical Considerations section for suggestions for practice regarding the I statement.


  • Rationale:

    Importance

    By 2020, approximately 12.3 million individuals in the United States older than 50 years are expected to have osteoporosis.1 Osteoporotic fractures, particularly hip fractures, are associated with limitation of ambulation, chronic pain and disability, loss of independence, and decreased quality of life, and 21% to 30% of patients who experience a hip fracture die within 1 year.2 Seventy-one percent of osteoporotic fractures occur among women,3 and women have higher rates of osteoporosis than men at any given age; however, men have a higher fracture-related mortality rate than women.24 The prevalence of primary osteoporosis (ie, osteoporosis without underlying disease) increases with age and differs by race/ethnicity. With the aging of the US population, the potential preventable burden is likely to increase in future years.1

    Detection

    The USPSTF found convincing evidence that bone measurement tests are accurate for predicting osteoporotic fractures in women and men. The most commonly used test is central dual-energy x-ray absorptiometry (DXA) of the hip and lumbar spine. Although several bone measurement tests similarly predict risk of fracture, DXA provides measurement of bone mineral density (BMD), and most treatment guidelines use central DXA to define osteoporosis and the threshold at which to start drug therapies to prevent osteoporotic fractures. The USPSTF found adequate evidence that clinical risk assessment tools are moderately accurate in identifying risk of osteoporosis and osteoporotic fractures.

    Benefits of Early Detection and Treatment

    The USPSTF found 1 study that evaluated the effect of screening for osteoporosis on fracture rates; the study reported a reduction in hip fractures but did not find a reduction in other types of fractures.4-6

    Multiple studies show that drug therapies reduce fractures in postmenopausal women with osteoporosis. For women 65 years and older, the USPSTF found convincing evidence that screening can detect osteoporosis and that treatment of women with osteoporosis can provide at least a moderate benefit in preventing fractures. For postmenopausal women younger than 65 years who are at increased risk of osteoporosis, the USPSTF found adequate evidence that screening can detect osteoporosis and that treatment provides a moderate benefit in preventing fractures.

    For men, the USPSTF found inadequate evidence on the benefits and harms of treating screen-detected osteoporosis to reduce the risk of osteoporotic fractures.

    Harms of Early Detection and Treatment

    The USPSTF found a single study that described harms of screening for osteoporosis. It reported no increase in anxiety and no decrease in quality of life from screening.4-6 Based on the nature of screening with bone measurement tests and the low likelihood of serious harms, the USPSTF found adequate evidence to bound these harms as no greater than small. Harms associated with screening may include radiation exposure from DXA and opportunity costs (time and effort required by patients and the health care system).

    Harms of drug therapies for osteoporosis depend on the specific medication used. The USPSTF found that the risk of serious adverse events, upper gastrointestinal events, or cardiovascular events associated with the most common class of osteoporosis medication (bisphosphonates) is no greater than small. Overall, the USPSTF found adequate evidence that the harms of osteoporosis medications are small.

    USPSTF Assessment

    The USPSTF concludes with moderate certainty that the net benefit of screening for osteoporosis in women 65 years and older is at least moderate.

    The USPSTF concludes with moderate certainty that the net benefit of screening for osteoporosis in postmenopausal women younger than 65 years who are at increased risk of osteoporosis is at least moderate.

    The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis in men.

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