Screening Women >65
New Recommendation: All Women Older Than 65 Should Be Routinely Screened for Osteoporosis
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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 using dual-energy X-ray absorptiometry (DXA). The recommendation applies to all racial and ethnic groups and became effective on January 18, 2011.
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.
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.
The USPSTF, which is convened by the Agency for Healthcare Research and Quality (AHRQ), is an independent panel of private-sector experts in prevention and evidence-based medicine that conducts rigorous, impartial assessments of the scientific evidence and makes recommendations on the effectiveness of a broad range of clinical preventive services, including screening, counseling and preventive medications. The USPSTF does not consider costs or cost-effectiveness in creating recommendations.
Published on January 18, 2011
Source: U.S. Preventive Services Task Force. Screening for osteoporosis: U.S. Preventive Services Task Force Recommendation Statement [published online ahead of print January 17, 2011]. Ann Int Med.
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