New recommendations from the U.S. Preventive Services Task Force, or USPSTF, could significantly lower the age at which family physicians begin screening some women for osteoporosis.
The recommendations effectively build on those issued in 2002, when the task force and the AAFP recommended routine osteoporosis screening for women ages 65 years and older, as well as routine screening for women ages 60 and older who are at increased risk for osteoporotic fractures. The updated recommendations(www.uspreventiveservicestaskforce.org), which were released Jan. 18, retain the screening indication for women ages 65 and older. But now, according to family physician and USPSTF Chairman Ned Calonge, M.D., M.P.H., the task force also recommends screening "all postmenopausal women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors."
In an interview with AAFP News Now, Calonge said that a number of factors can put women at increased risk for osteoporosis, including
- excessive alcohol use,
- family history and
- low body mass index.
"The combination of risk factors can put a woman at high-enough risk for osteoporosis that screening at a younger age is warranted," said Calonge, who also is president and CEO of the Denver-based Colorado Trust.
American Family Physician's new feature, AFP By Topic, offers up-to-date clinical content to help guide family physicians caring for patients who have or are at risk for osteoporosis (some content available to members and paid subscribers only). Topics covered include screening and diagnosis, treatment and fracture prevention, patient education and self-care, and practice improvement tips.
The task force gave the new recommendations a grade B ranking, which means the USPSTF recommends the service because there is "high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial." A provision of the Patient Protection and Affordable Care Act will require new health plans (i.e., plans that are established on or after Sept. 23, 2010) to cover and eliminate copays, deductibles and coinsurance amounts for preventive services rated "A" or "B" by the USPSTF.
The AAFP's Commission on Health of the Public and Science is reviewing the guidelines.
"I hope that family physicians make sure they look at osteoporosis screening as an important part of their clinical practice," Calonge said. "As guidelines change, 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."
Task Force Chair Describes New Process
Listen to a brief AAFP News Now audio interview(3:23 minute MP3) with family physician and U.S. Preventive Services Task Force Chairman Ned Calonge, M.D., M.P.H., in which he discusses the task force's augmented process for formulating recommendation statements.
According to the National Osteoporosis Foundation, about 8 million American women and 2 million men currently have osteoporosis, and 34 million more people have low bone mass, which is a risk factor for the disease.
The task force, however, determined that the evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis in men.
Calonge noted that this brief mention was an important difference from the 2002 recommendations, which did not address men at all. Since then, he said, there have been some small studies that suggest there may be some men who benefit from screening and treatment.
"The task force ran into difficulty, though, in that there's not enough research to make a recommendation one way or the other," said Calonge. "Our feeling is that since men do get osteoporosis -- they do get it less often and at later ages than women -- there may be a role for screening, but we need more research to fill in that gap."
In 2008, the American College of Physicians issued guidelines recommending that physicians periodically evaluate their older male patients for osteoporosis risk factors.
The USPSTF's new recommendations also address the pros and cons of two types of screening tests: dual-emission X-ray absorptiometry and quantitative ultrasound. In addition, the document covers drug therapies to help prevent fractures.
"The way the task force looked at things, we did consider all the potential therapies," Calonge said. "Individualized, I think, is the right approach. You want to make sure you use the medication approach that a woman is going to comply with and minimize her risk for adverse reactions. It's hard, on a global basis, to say one is better than the other. That's not really what the evidence review was for. But what we were able to say is that for the woman who is osteoporotic, it appears the risk of adverse events from medication were outweighed by the benefits of avoiding a fracture."