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USPSTF affirms osteoporosis recommendations
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The U.S. Preventive Services Task Force has issued draft recommendations that clinicians screen all women age older than 65 years for osteoporosis as well as postmenopausal women younger than 65 years who are at increased risk for osteoporosis. The task force gave these recommendations a ‘B’ grade.
The task force also issued other draft recommendation indicating that there is insufficient evidence to assess the balance of benefits and harms of screening men for osteoporosis.
Both statements mirror the task force 2011 final recommendations on osteoporosis, according to a press release.
“It’s important to remember that this recommendation only applies to patients with no signs or symptoms of osteoporosis, and that clinicians should talk with anyone who is concerned about fractures or their risk for osteoporosis,” task force member Alex Krist, MD, MPH, told Healio Family Medicine.
According to the International Osteoporosis Foundation, osteoporosis affects 200 million people worldwide.
“Osteoporosis can have a significant impact on people’s lives. Up to 30% of patients with a hip fracture die within 1 year of the fracture, and nearly 60% of those with a fracture need assistance with basic activities of daily living, such as eating and bathing,” Krist said. “And since there are usually no signs or symptoms of osteoporosis until a fracture occurs, screening can help clinicians identify and treat the disease early, before a fracture and subsequent issues occur.”
Krist, who is also a professor of family medicine and population health at Virginia Commonwealth University, provided ways that primary care physicians can implement these draft recommendations in their practices.
“The FRAX — Fracture Risk Assessment Tool — can help assess someone’s risk of osteoporosis or osteoporotic fracture. Primary care clinicians can also begin conversations about osteoporosis and bone health to help ensure that their patients are assessed for osteoporosis and treated as necessary to help them live longer, healthier lives.”
For those without access to the tool, the task force advised clinicians with postmenopausal female patients who are younger than 65 years and have low body weight, excessive alcohol consumption, smoking and/or parental history of hip fracture to use a “reasonable approach” to decide if the woman should undergo osteoporosis screening with bone measurement testing. Men have many of these same risk factors for fractures, according to the task force, but those with hypogonadism and history of cerebrovascular accidents or diabetes have an increased risk.
Although none of the task force current recommendations received an A grade, Krist said PCPs should still discuss osteoporosis with their patients.
“We encourage primary care physicians to talk to all women who are 65 or older about getting screened for osteoporosis. In addition, they should talk with younger postmenopausal women about their risk factors. Unfortunately, there isn’t enough research to assess the balance of benefits and harms of screening men for this condition,” he said, adding that PCPs should still be prepared to discuss bone health with any patient concerned about bone health.
Krist identified other gaps in the research that if filled, could potentially change future task force recommendations.
“There is a need to determine how often people should be screened. In addition, more studies are needed to determine whether the clinical risk assessment tools that identify patients at risk can also be used to help clinicians identify who could be treated to prevent fractures without additional follow-up bone measurement testing.”
The USPSTF’s draft statement and evidence review has been posted for public comment on the USPSTF website. Input will be accepted through Dec. 4, 2017 at www.uspreventiveservicestaskforce.org/tfcomment.htm. – by Janel Miller
Reference: International Osteoporosis Foundation. Epidemiology. https://www.iofbonehealth.org/epidemiology. Accessed Nov. 2, 2017.
Disclosures: Krist reports no relevant financial disclosures. Healio Family Medicine was unable to determine the other authors’ relevant financial disclosures prior to publication.