USPSTF recommends women of ages 65 and above to routinely screen for osteoporosis

In an update to its 2002 recommendation, the U.S. Preventive Services Task Force (USPSTF) now recommends that all women ages 65 and older be routinely screened for osteoporosis. This is the first final recommendation statement to be published since the USPSTF implemented a new process in July 2010 in which all of its draft recommendation statements are posted for public comment on the USPSTF website prior to being issued in final form. The draft recommendation statement on screening for osteoporosis was posted for public comment from July 6 to August 3, 2010.

The USPSTF also 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. Risk factors for osteoporosis include tobacco use, alcohol use, low body mass and parental history of fractures.

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 also looked at whether to recommend screening men for osteoporosis but found insufficient evidence to make a recommendation at this time. This new final recommendation will become effective when it appears in the January 18 online issue of Annals of Internal Medicine and will also be available on the USPSTF website.

"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," said Task Force Chair Ned Calonge, M.D., who is also the president and CEO of The Colorado Trust. "Clinicians also should talk to their younger patients to learn if they have risk factors that mean they should be screened."

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.