USPSTF: Screen older and at-risk postmenopausal women for osteoporosis

Key takeaways:

• The USPSTF’s draft recommendation on osteoporosis screening is largely consistent with its 2018 statement.
• The task force is calling for more research on the benefits and harms of screening in men.

The U.S. Preventive Services Task Force has issued a draft recommendation stating that all women aged 65 years and older be screened for osteoporosis to prevent fractures.

The USPSTF also recommends screening postmenopausal women aged younger than 65 years who are at an increased risk for an osteoporotic fracture.

Both are B-grade recommendation statements.

Because of a lack of research, the task force was unable to make a recommendation for or against osteoporosis screening in men, an I statement.

The recommendations apply to adults with no prior fragility fractures or conditions that could weaken the bones, according to a press release.

“It’s really important for women to be screened for osteoporosis to help prevent osteoporotic fractures because these fractures end up increasing morbidity and death,” USPSTF member Esa Davis, MD, MPH, a professor and associate vice president for community health, and the senior associate dean of population and community medicine at the University of Maryland School of Medicine, told Healio. “While most of the focus will be on the B recommendations for screening in women, we certainly do not want to forget about men. Osteoporosis and fractures do occur in men and lead to the same kind of morbidity and mortality. So, we are calling for more research in that group.”

The draft recommendation is mostly consistent with the USPSTF’s 2018 recommendation in this area. However, unlike the previous recommendation, the task force does not specifically reference using bone mineral density (BMD) alone as a screening tool in women aged 65 years and older. Instead, the task force said BMD can be used with or without risk assessment in this group.

For women aged younger than 65 years, the task force recommends screening only those who went through menopause, have at least one risk factor and have been assessed to be at increased risk. There are several risk assessment tools that clinicians can use to determine whether screening in this group is warranted, according to Davis. These include the Osteoporosis Self-assessment Tool and the Osteoporosis Risk Assessment Instrument, both of which can be used to assess the likelihood of having osteoporosis. There is also the Garvan Fracture Risk Calculator and the more commonly used Fracture Risk Assessment Tool (FRAX), which can help clinicians determine whether a patient is at risk for a major osteoporotic fracture, Davis said.

All these risk assessment tools have limitations, she added. The evidence behind them is largely based on small cohort studies, many of which were conducted 30 to 40 years ago, particularly for FRAX, Davis noted. Importantly, she said the trials lacked diverse populations such as non-Hispanic Black and Hispanic patients.

“In those populations, the FRAX, for instance, may underestimate the risk for fracture,” she said. “That’s what you may see with many of these tools. So, just be aware of those limitations and do not rely solely on these tools to predict risk but use them in conjunction with other clinical factors. In fact, this is one of the other things we call out for in the recommendation. It’s important to get more research on these tools, particularly in populations that are more contemporary and more representative by race and ethnicity.”

The draft recommendation statement is available for public comment here. Comments can be submitted up to July 8, 2024.