Task force issues final recommendation on osteoporosis screening in older women

Key takeaways:

• The USPSTF recommended that all women aged 65 years or older be screened for osteoporosis.
• Younger postmenopausal women assessed to be at higher risk and have at least one risk factor should also be screened.

In a final recommendation statement, the U.S. Preventive Services Task Force said that all women aged 65 years and older should 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 and apply to adults who do not have a history of fragility fractures or health conditions that could weaken bones.

The task force could not make a recommendation for or against osteoporosis screening in men because of a lack of research.

“Too often, the first sign of osteoporosis is a broken bone, which can lead to serious health issues,” USPSTF member Esa Davis, MD, MPH, professor of family and community medicine at the University of Maryland School of Medicine, said in a press release. “The good news is that for women 65 years or older, as well as younger women at increased risk, screening can detect osteoporosis early — before fractures happen — helping women maintain their health, independence, and quality of life.”

The guidance is consistent with the draft recommendation published last year and mostly consistent with the USPSTF’s 2018 recommendation on the topic, but unlike the latter 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.

Now, BMD can be used with or without risk assessment in this population, the USPSTF said.

For women aged younger than 65 years, the task force recommends screening those who are postmenopausal, have at least one risk factor and have been assessed to be at increased risk.

According to the USPSTF, there are several assessment tools that can be used to estimate a person’s future risk for fracture, such as the Fracture Risk Calculator, Garvan Fracture Risk Calculator and the Fracture Risk Assessment Tool.

There are also the Osteoporosis Risk Assessment Instrument and Osteoporosis Self-assessment Tool, which can be used by clinicians to identify osteoporosis.

However, many of these risk assessment tools have limitations in predicting fracture risk for Asian, Hispanic and Black populations, which clinicians should be aware of, the USPSTF noted.

Ultimately, “the task force continues to call for more research in men and encourages anyone concerned about their bone health to speak with their clinician,” USPSTF vice chair John Wong, MD, said in the release.

In a related editorial, Kristine E. Ensrud, MD, MPH, a professor at the University of Minnesota School of Public Health, and Carolyn J. Crandall, MD, MS, FACP, a professor in the department of medicine at the University of California, Los Angeles, explained that screening for osteoporosis in younger postmenopausal women may be a challenge because of several factors like:

• time constraints;
• a lack of resources;
• an absence of tools that accurately estimate long-term fracture risk in this population; and
• gaps in evidence on the harms and benefits of starting osteoporosis drug treatment for fracture prevention in postmenopausal women aged 50 to 64 years and continuing the treatment uninterrupted or with temporary pauses throughout the rest of their lifetime.

As a result, future investigations into the benefits and harms of osteoporosis screening “should consider not only the validity and reliability of proposed strategies but also the feasibility and practicality of their application in clinical practice,” they wrote.

References:

• Ensrud K, Crandall C. JAMA. 2025;doi:10.1001/jama.2024.27416.
• U.S. Preventive Services Task Force issues final recommendation on screening for osteoporosis to prevent fractures. Available at: https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/osteoporosis-screening-final-rec-bulletin.pdf. Published Jan. 14, 2025. Accessed Jan. 14, 2025.
• USPSTF. JAMA. 2025;doi:10.1001/jama.2024.27154.
• USPSTF. JAMA. 2025;doi:10.1001/jama.2024.21653.