Heidi D. Nelson, MD, MPH; Mark Helfand, MD, MPH; Steven H. Woolf, MD, MPH; Janet D. Allan, PhD, RN
Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the U.S. Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Acknowledgments: The authors thank Peggy Nygren, MA; Nancy Carney, PhD; Kathryn Pyle Krages, AMLS, MA; Benjamin Chan, MS; and the reviewers of the full evidence report for their contributions to this project.
Grant Support: This study was conducted by the Oregon Health & Science University Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality, Rockville, Maryland (contract no. 290-97-0018, task order nos. 2 and 4).
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Current Author Addresses: Drs. Nelson and Helfand: Oregon Health & Science University, Mail Code BICC 504, 3181 SW Sam Jackson Park Road, Portland, OR 97201.
Dr. Woolf: Virginia Commonwealth University, Department of Family Practice, 3712 Charles Stewart Drive, Fairfax, VA 22033.
Dr. Allan: School of Nursing, the University of Maryland Baltimore, 655 West Lombard, Room 725, Baltimore, MD 21201.
Although osteoporotic fractures present an enormous health burden, it is not clear whether screening to identify high-risk persons is appropriate.
To examine evidence on the benefits and harms of screening postmenopausal women for osteoporosis.
MEDLINE (1966 to May 2001), HealthSTAR (1975 to May 2001), and Cochrane databases; reference lists; and experts.
English-language abstracts that included original data about postmenopausal women and osteoporosis and addressed the effectiveness of risk factor assessment, bone density tests, or treatment were included.
Selected information about patient population, interventions, clinical end points, and study design were extracted, and a set of criteria was applied to evaluate study quality.
No trials of the effectiveness of screening have been published. Instruments developed to assess clinical risk factors for low bone density or fractures have moderate to high sensitivity and low specificity. Among different bone density tests measured at various sites, bone density measured at the femoral neck by dual-energy x-ray absorptiometry is the best predictor of hip fracture. Women with low bone density have approximately a 40% to 50% reduction in fracture risk when treated with bisphosphonates.
Population screening would be based on evidence that the risk for osteoporosis and fractures increases with age, that the short-term risk for fracture can be estimated by bone density tests and risk factors, and that fracture risk can be reduced with treatment. The role of risk factor assessment and different bone density techniques, frequency of screening, and identification of subgroups for which screening is most effective remain unclear.
Table 1. Risk Factors for Fractures in Women 50–65 Years of Age
Table 2. Studies of Risk Factor Assessment
Table 3. Prospective Studies of Dual-Energy X-Ray Absorptiometry and Ultrasonography That Reported Hip Fractures
Table 4. Randomized, Controlled Trials of Alendronate with Fracture Outcomes
Table 5. Screening for Osteoporosis in 10 000 Postmenopausal Women: Hip and Vertebral Fracture Outcomes by 5-Year Age Intervals
Number needed to screen to prevent one hip fracture in 5 years.
Appendix Table 1. Summary of Evidence Quality
Appendix Table 2. Formulas for Calculations in Outcomes Table
Appendix Table 3. Criteria for Grading the Internal Validity of Individual Studies
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Nelson HD, Helfand M, Woolf SH, Allan JD. Screening for Postmenopausal Osteoporosis: A Review of the Evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2002;137:529-541. doi: 10.7326/0003-4819-137-6-200209170-00015
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Published: Ann Intern Med. 2002;137(6):529-541.
Endocrine and Metabolism, Guidelines, Metabolic Bone Disorders.
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