medwireNews: The US Preventive Services Task Force (USPSTF) has published a recommendation statement on screening for osteoporosis to reduce fracture risk.
As reported in JAMA, Meera Viswanathan (RTI International, Research Triangle Park, North Carolina, USA) and colleagues carried out a systematic review and meta-analysis of 168 studies assessing the impact of screening, bone measurement tests, clinical assessments, or drug treatment on fracture risk. The USPSTF authors, led by Susan Curry (University of Iowa, Iowa City, USA), then used this updated evidence to develop their recommendations.
Curry and colleagues say that there is “convincing evidence” that bone measurement tests can accurately detect osteoporosis and predict fracture risk in men and women, along with “adequate evidence” suggesting that clinical risk assessment tools can identify osteoporosis and fracture risk with moderate accuracy. Furthermore, they found “convincing evidence” supporting the use of drug treatment to reduce fracture risk in postmenopausal women.
Based on these findings, the taskforce recommends screening with bone measurement tests in women aged 65 years and older, as well as postmenopausal women aged younger than 65 years who are at increased risk for osteoporosis, as determined by a clinical risk assessment tool, to reduce their risk for osteoporotic fractures. They note that the recommendations for both populations are USPSTF grade B, meaning that “[t]here is high certainty that the net benefit is moderate, or there is moderate certainty that the net benefit is moderate to substantial.”
Commenting on these recommendations in an editorial published in JAMA Internal Medicine, Margaret Gourlay (University of North Carolina at Chapel Hill) agrees that “existing evidence supports routine osteoporosis screening in women 65 years or older.”
However, she believes that the “evidence is inconclusive” for postmenopausal women under 65 years of age, and that the recommendation “would be better characterized by an I statement; ie, the evidence is insufficient to determine the balance between benefits and harms.”
The guideline authors used such a statement to describe the evidence base for osteoporosis screening in men.
“[T]he current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures in men,” they say.
When women with low bone mineral density have been identified through screening, there are a number of treatment options to treat osteoporosis and reduce fracture risk, say the guideline authors. They highlight that bisphosphonates are the most extensively studied option, followed by denosumab, parathyroid hormone, raloxifene, and estrogen.
“The choice of therapy should be an individual one based on the patient's clinical situation and the trade-off between benefits and harms,” they write.
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