USPSTF: Screen All Women 65 and Older for Osteoporosis

Screen At-risk Women Younger Than 65, but Not Men

November 10, 2017 01:33 pm Chris Crawford

On Nov. 7, the U.S. Preventive Services Task Force (USPSTF) posted a draft recommendation statement(www.uspreventiveservicestaskforce.org) and draft evidence review(www.uspreventiveservicestaskforce.org) on screening for osteoporosis to prevent fractures.  

[Older patient being examined]

Based on its review of the evidence, the USPSTF recommended screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 and older -- a "B" recommendation. (www.uspreventiveservicestaskforce.org)

The task force also recommended screening for osteoporosis with bone measurement testing in postmenopausal women younger than 65 who are at increased risk for osteoporosis; this was also a "B" recommendation.

"Without screening, most women won't know that they have osteoporosis until they have a fracture. The task force found that screening for osteoporosis can help clinicians identify and treat the disease early to help prevent fractures," said USPSTF member Alex Krist, M.D., M.P.H., in a news release.(www.uspreventiveservicestaskforce.org)  

Story highlights
  • On Nov. 7, the U.S. Preventive Services Task Force (USPSTF) posted a draft recommendation statement and draft evidence review on screening for osteoporosis to prevent fractures.
  • Based on its review of the evidence, the USPSTF recommended screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 and older -- a "B" recommendation.
  • The task force also issued a "B" recommendation on screening for osteoporosis with bone measurement testing in postmenopausal women younger than 65 who are at increased risk for osteoporosis.

Finally, the USPSTF found insufficient evidence to assess the balance of benefits and harms of screening men for osteoporosis to prevent osteoporotic fractures and gave this practice an "I" recommendation.

The USPSTF said this updated draft recommendation statement is consistent with the group's 2011 final recommendation on screening for osteoporosis, which also found benefit in screening women 65 and older, as well as younger women at increased risk.

The AAFP agreed with that 2011 guidance in its own recommendation issued at the time.

To develop its draft recommendation statement, the USPSTF commissioned a systematic review to identify updated evidence published since its 2011 recommendation and to examine newer evidence on screening for and treatment of osteoporotic fractures in women and men. The review also looked for evidence on risk assessment tools, screening intervals, and efficacy of screening and treatment in various subgroups.

The task force defined the screening population as postmenopausal women and older men with no history of previous osteoporotic fractures and no known comorbid conditions or medication use associated with secondary osteoporosis. The review excluded adults younger than age 40.

The task force said the only major change from 2011 is that the USPSTF expanded its consideration of evidence related to fracture risk assessment, with or without bone mineral density (BMD) testing, for this draft recommendation.

Family Physician's Take

Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, told AAFP News that although this draft recommendation is generally unchanged from the 2011 recommendation, the previous guidance defined its recommendation for younger women as pertaining to those "whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors" -- a definition based on using the Fracture Risk Assessment (FRAX) tool(www.sheffield.ac.uk) developed from studying population-based cohorts in various parts of the world.

Frost said the current draft recommendation is not specifically tied to FRAX and discusses other tools as options to determine risk. These include the Simple Calculated Osteoporosis Risk Estimation, the Osteoporosis Risk Assessment Instrument, the Osteoporosis Index of Risk and the Osteoporosis Self-Assessment Tool, all of which have accuracy levels similar to that of the FRAX tool.

These tools have different thresholds to indicate increased risk, so the draft recommendation's language was adjusted from the 2011 guidance to include them, she said. The thresholds for the different tools are listed in the Clinical Considerations(www.uspreventiveservicestaskforce.org) section of the draft statement.

Common bone measurement tests used to screen for osteoporosis include central dual-energy X-ray absorptiometry (DXA) and quantitative ultrasound (QUS). DXA measures BMD at central sites (hip and lumbar spine) or peripheral sites (e.g., wrist, forearm and calcaneus). QUS evaluates peripheral sites and has similar accuracy in predicting fracture risk as DXA -- while avoiding the risk of radiation exposure -- but it doesn't measure BMD.

And although age is the biggest risk factor associated with women's chance of developing osteoporosis, risk factors that put younger women at increased risk include low body weight, current tobacco use, excessive alcohol consumption, a history of fractures and chronic corticosteroid use, Frost said.

As for the "I" statement on screening men for osteoporosis, Frost said that although the tools available can assess risk in men, there still aren't enough data to determine whether treatment of osteoporosis is effective in decreasing fractures in the male population.

However, the AAFP has endorsed the American College of Physicians' guideline on treatment for osteoporosis, which recommends treatment with bisphosphonates in men with clinically identified (not screen-detected) osteoporosis, based on low-quality evidence.

Up Next

The USPSTF is inviting comments on its draft recommendation statement(www.uspreventiveservicestaskforce.org) and draft evidence review(www.uspreventiveservicestaskforce.org) until 8 p.m. EST on Dec. 4. All comments received will be considered as the task force prepares its final recommendation.

The AAFP will review the USPSTF's draft recommendation statement and supporting evidence and provide comments to the task force. The Academy will release its own recommendation on the topic after the task force finalizes its guidance.

Related AAFP News Coverage
USPSTF Draft Recommendations Address Falls, Fractures
(9/28/2017)

AAFP Endorses ACP Guideline on Treating Osteoporosis
(5/11/2017)

More From AAFP
American Family Physician: AFP By Topic: Osteoporosis

Familydoctor.org: Osteoporosis(familydoctor.org)