All women 65 and older, and now younger women with increased risk factors for osteoporosis, should be routinely screened for the bone-thinning condition, the U.S. Preventive Services Task Force now says in its expanded recommendations.
The announcement, released in a task force statement Monday and appearing in the online issue of Annals of Internal Medicine Tuesday, is an update to the USPSTF 2002 recommendation.
"As the number of people over the age of 65 in the United States increases, osteoporosis screening continues to be important in detecting women at risk who will benefit from treatment to prevent fractures," Task Force Chair Dr. Ned Calonge, who is also the president and CEO of The Colorado Trust, said in the written statement. "Clinicians also should talk to their younger patients to learn if they have risk factors that mean they should be screened."
The USPSTF recommends that younger women with increased risk factors for osteoporosis be screened if their fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors. White women are used as the benchmark because they have a markedly higher rate of osteoporosis and fractures than other ethnic groups, according to the task force statement. Risk factors for osteoporosis include tobacco use, alcohol use, low body mass, and parental history of fractures.
Osteoporosis, a condition that occurs when bone tissue thins or develops small holes, can cause pain, broken bones, and loss of body height. Osteoporosis is more common in women than men and is more common in whites than any other racial group. For all demographic groups, the rates of osteoporosis rise with increasing age.
The USPSTF did not indicate a specific age limit at which screening should no longer be offered because the risk for fractures continues to increase with age, and the evidence indicates that benefits can be realized within 18 to 24 months after starting treatment. The USPSTF found insufficient evidence to recommend screening men.
Osteoporosis screening involves a measurement of bone density, which is currently covered by Medicare. The most commonly used bone density measurement tests are dual-energy X-ray absorptiometry (DXA) of the hip and lumbar spine, as well as quantitative ultrasound of the heel, although current diagnostic and treatment criteria are based on DXA tests alone. The USPSTF noted that there is a lack of evidence about how often screening should be repeated in women whose first test is negative.
In postmenopausal women who have no prior fractures caused by osteoporosis, the USPSTF found convincing evidence that drug therapies (including bisphosphonates, parathyroid hormone, raloxifene, and estrogen) reduce the risk for osteoporosis-related fractures, according to the task force statement.
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