OHSU Analysis prompts first U.S. Preventive Task Force recommendation on osteoporosis screening
The U.S. Preventive Services Task Force today recommended that women aged 65 and older be routinely screened for osteoporosis to reduce the risk of fracture and spinal abnormalities often associated with the disease. The Task Force also recommended that routine screening begin at age 60 for those women identified as high risk because of their weight or estrogen use.
The Task Force is an independent panel of experts sponsored by the Agency for Healthcare Research and Quality (AHRQ). The recommendations, which are published in the September 17 Annals of Internal Medicine, mark the first time the Task Force has called for routine osteoporosis screening.
For women who live to be 85, approximately 50 percent will have an osteoporosis-related fracture during their lives; 25 percent of these women will develop an abnormality of the spine; and 15 percent will fracture their hip. While no clinical studies have been done to assess the effectiveness of screening in reducing osteoporotic fractures, there is ample evidence that bone density testing can adequately identify women who could benefit from treatment. A new class of drugs called bisphosphonates has proved effective at reducing the risk of fracture in women with low bone density, leading the Task Force to believe that screening can be beneficial.
"As the number of people in our country over 65 continues to grow, osteoporosis screening is taking on a new importance," said Health and Human Services Secretary Tommy G. Thompson.
"The evidence shows that the risk for osteoporosis and fractures increases with age, and the means are now available to detect low bone density and treat it," said Heidi D. Nelson, M.D., M.P.H., of the Evidence-based Practice Center at Oregon Health & Science University. Nelson led the evidence review along with Mark Helfand, M.D., M.P.H., and a team of researchers at OHSU.
One variable for physicians to consider is that several technologies are available to measure bone density. Dual-energy X-ray absorptiometry, known as DEXA, is considered the best because it is the most extensively validated test against fracture outcomes. Published studies consistently show that the probability of receiving a diagnosis of osteoporosis depends on the choice of technology and site of the test (forearm, hip, heel, etc.). The optimal frequency of testing is unclear, but intervals of two to five years are most consistent with current understanding of the tests.
The benefits of screening large segments of the population for osteoporosis are tempered by harms of testing. Potential harms may arise from inaccuracies and misinterpretations of bone density tests. False positives could lead to inappropriate treatment and false negatives could lead to missed treatment opportunities. Costs of tests and treatment are also factors to consider when screening. Also, fear and anxiety often accompany a diagnosis of osteoporosis, just as with any medical ailment.
The U.S. Preventive Services Task Force, the leading independent panel of private-sector experts in prevention and primary care, conducts rigorous, impartial assessments of all the scientific evidence for a broad range of preventive services. Its recommendations are considered the gold standard for clinical preventive services.
The Task Force recommendations and materials for clinicians are available on the Web at http://www.ahrq.gov/clinic/3rduspstf/osteoporosis/.