Proposed guidelines would expand osteoporosis screening

In a set of draft guidelines, the U.S. Preventive Services Task Force recommends women undergo bone density screening for osteoporosis at age 65 years, as well as those at increased risk for osteoporosis at any age.

This is the first proposed update since 2002, when the U.S. Preventive Services Task Force (USPSTF) recommended bone density screening for women aged 65 years and older and for those aged 60 to 64 years at increased risk for fracture. However, no recommendation was specified for screening other groups of women or men.

The draft guidelines are the result of an evidence-based review of studies and information published since the 2002 guidelines. The task force assessed the safety and efficacy of osteoporosis screening and therapies in reducing the risk for fracture; performance of risk-assessment tools and bone density screening on diagnosis of osteoporosis; and favorable screening intervals.

Pooled data

Data were pooled from randomized controlled trials with fracture outcomes; studies of risk-assessment tools; systematic reviews; and population-based studies of bone density screenings or therapy impairment. All studies were conducted between January 2001 and December 2009.

“Although methods to identify the risk for osteoporotic fractures are available and medications to reduce fractures are effective, no trials directly evaluate screening effectiveness, harms and intervals,” the task force wrote.

The task force found evidence that risk-assessment tools predict decreased bone mineral density and fractures; DXA predicts fractures equally for men and women; and calcaneal quantitative ultrasonography predicts fractures of the femoral neck, hip or spine in men and women, but the association with DXA is low.

Decreased vertebral fractures

Further, evidence on osteoporosis therapies revealed that use of bisphosphonates, parathyroid hormone, raloxifene and estrogen decreases primary vertebral fractures in postmenopausal women. However, studies on bisphosphonates used as primary prevention in men are lacking, according to the task force.

The USPSTF invites public comment on the draft recommendations before the final statement is published. The draft is available for public comment here. The USPSTF said it will consider public comments when finalizing the updated recommendations for publication in Annals of Internal Medicine.

Refrence:
Nelson HD. Annals Intern Med. 2010;153.