USPSTF updates osteoporosis screening guidelines for men, women

Osteoporosis screening is appropriate in women aged 65 years or older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman, according to updated recommendations from the U.S. Preventive Services Task Force.

The article was released early online on Jan. 17 by Annals of Internal Medicine.

Based on the FRAX tool, a 65-year-old white woman with no other risk factors has a 9.3% 10-year risk for an osteoporotic fracture and should be screened. (Clinicians also should consider each patient's values and preferences and use clinical judgment when discussing screening, the guidelines noted.) White women between the ages of 50 and 64 years with equivalent or greater 10-year fracture risks based on specific risk factors are also recommended for screening. That would include, for example:

• a 50-year-old current smoker with a BMI less than 21 kg/m², daily alcohol use, and parental fracture history,a 55-year-old woman with a parental fracture history,a 60-year-old woman with a BMI less than 21 kg/m² and daily alcohol use, anda 60-year-old current smoker with daily alcohol use.

Evidence is lacking about optimal intervals for repeated screening, the guidelines found. The choice of treatment should take into account the patient's clinical situation and the tradeoff between benefits and harms. Clinicians should provide education about how to minimize drug side effects. Treatments include adequate calcium and vitamin D intake and weight-bearing exercise, as well as FDA-approved therapies to reduce fracture risk in women with low bone mineral density and no previous fractures, including bisphosphonates, parathyroid hormone, raloxifene, and estrogen.

The USPSTF expanded its review to include men, but concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis in men (I statement). Men most likely to benefit from screening have a 10-year risk for osteoporotic fracture equal to or greater than that of a 65-year-old white woman without risk factors. Because of the lack of relevant studies, the USPSTF found inadequate evidence that drug therapies reduce the risk for fractures in men who have no previous osteoporotic fractures. The USPSTF identified the absence of randomized trials of primary fracture prevention in men who have osteoporosis as a critical gap in the evidence.

The recommendations in women apply to all racial and ethnic groups because the harms of the screening tests are usually small, the consequences of failing to identify and treat women who have low bone mineral density are considerable, and the optimal alternative age at which to screen nonwhite women is uncertain. The quantity and quality of data on osteoporotic fracture risk other than hip fracture are much less for Asian, American Indian or Alaska Native, Hispanic, and black women than for whites. The FRAX tool also predicts 10-year fracture risks for black, Asian, and Hispanic women in the United States. In general, estimated fracture risks in nonwhite women are lower than those for white women of the same age.

A patient summary is available online and the text will be published in the March 1 issue of Annals of Internal Medicine.

ACP Internist published an article in 2008 on the College's guidelines for osteoporosis screening in men.