Women as young as 50 "with an equivalent fracture risk" to a 65-year-old woman (smoking, low BMI, family history, excessive alcohol use) should be screened.
The United States Preventive Services Task Force unveiled new recommendations for osteoporosis screening that will significantly lower the age at which some women will undergo risk assessment testing.
The recommendations were rated at the “B” grade level, meaning that “there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.”
Though the USPSTF concluded that “no controlled studies have evaluated the effect of screening for osteoporosis on fracture rates or fracture-related morbidity or mortality,” there was “convincing evidence that drug therapies reduce the risk for fractures…in younger women whose fracture risk is equal to or greater than that of a 65-year-old woman who has no additional risk factors.”
The benefits of screening for osteoporosis in this demographic, they say, are “at least moderate,” as the USPSTF has found “no new studies that described harms of screening for osteoporosis in men or women.” USPSTF recognizes that harm is associated with bisphosophonates, estrogen, and selective estrogen receptor modulators, but is confident that the risks are “no greater than small” and “small to moderate.”
To assess a woman’s ten-year fracture risk, USPSTF used the FRAX tool and concluded that “a 65-year-old white woman with no other risk factors has a 9.3% 10-year risk for any osteoporitic fracture.” Younger women (“white women between the ages of 50 and 64 years”) with an equivalent risk “include but are not limited to the following:”
The USPSTF also calculated 10-year fracture risks for black, Asian, and Hispanic women in the United States, but estimates that, in general, “fracture risks in non-white women are lower than those for white women of the same age.”
Still, the USPSFT cautions clinicians not to blindly adhere to these recommendations, but “consider each patient's values and preferences and use clinical judgment when discussing screening with women in this age group. Menopausal status is one factor that may affect a decision about screening in this age group.”
Though 2 million American men have osteoporosis, the USPSTF concluded that there is a “lack of relevant studies” regarding drug therapies and fracture risk reduction in men, and accordingly did not make any recommendations.
They did say, however, that if a clinician decided to screen a male patient for osteoporosis, they should consider potential preventable burden (“bone measurement tests may potentially detect osteoporosis in a large number of men and prevent a substantial part of the burden of fractures and fracture-related illness in this population”), potential harms (“potential harms of screening men are likely to be small and consist primarily of opportunity costs”), current practice (“routine screening of men currently is not a widespread practice”), and costs (“m any additional DXA scanners may be required to screen sizeable populations of men for osteoporosis; DXA machines range in cost from $25,000 to $85,000”).
In conversation with the American Academy of Family Physicians, USPSTF Chairman Ned Calonge, MD, MPH indicates that he hopes “that family physicians make sure they look at osteoporosis screening as an important part of their clinical practice.”
“As guidelines change,” he continues, “sometimes we're slow to implement these into practice. I think the evidence supporting screening and treating women for osteoporosis is really very good and something that, hopefully, our colleagues will look at as an important part of their practice.”