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Screening for Osteoporosis: Recommendations From the U.S. Preventive Services Task Force FREE

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The full report is titled “Screening for Osteoporosis: U.S. Preventive Services Task Force Recomm-endation Statement.” It is in the 1 March 2011 issue of Annals of Internal Medicine (volume 154, pages 356-364). The author is the U.S. Preventive Services Task Force.

Ann Intern Med. 2011;154(5):I-40. doi:10.7326/0003-4819-154-5-201103010-00309
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Who developed these guidelines?

The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that reviews published research and makes recommendations about preventive health care.

What is the problem and what is known about it so far?

Osteoporosis causes bones to become less dense and break or fracture easily. White people have a higher risk for osteoporosis than members of other ethnic groups, but this condition occurs in all groups. Approximately half of all postmenopausal women and 1 out of every 5 men older than 65 years will experience an osteoporosis-related fracture. Fractures can lead to pain, loss of independence, and death.

Adequate calcium and vitamin D intake, exercise, and avoiding tobacco and alcohol help to prevent osteoporosis. Drugs can prevent osteoporosis, but they are not recommended for general prevention because of their adverse effects and expense. Instead, the USPSTF recommends screening for osteoporosis and then prescribing drugs only to people who have this condition. Screening involves measuring bone density using dual-energy x-ray absorptiometry (DXA). Newer tests use other x-ray techniques and ultrasonography.

How did the USPSTF develop these recommendations?

The USPSTF reviewed research published between January 2001 and December 2009 to identify new information about the benefits and harms of osteoporosis screening since the group's 2002 recommendations.

What did the authors find?

No studies directly evaluated whether patient outcomes improve after screening or what the best frequency of screening is. Dual-energy x-ray absorptiometry predicts fractures in both men and women. Ultrasonography of the heel also predicts fractures but is less well studied than DXA. In postmenopausal women, bisphosphonates, calcitonin, parathyroid hormone, raloxifene, and estrogen reduce fractures; studies of treatment in men are lacking. Although there are reports of stomach upset, ulcers, abnormal heart rhythms, and jaw problems associated with bisphosphonates, no proven relationship exists among bisphosphonates and these or more serious adverse effects. Thigh bone, or femur, fractures have been reported, especially in women using bisphosphonates for more than 5 years. Blood clots can occur with raloxifene and estrogen. Also, estrogen is linked to heart attacks, strokes, and breast cancer. Little is known about the adverse effects of calcitonin and parathyroid hormone.

What does the USPSTF suggest that patients and doctors do?

The USPSTF recommends that women 65 years of age or older undergo osteoporosis screening. Approximately 9 out of every 100 white women who are 65 years of age with no risk factors for osteoporosis will have an osteoporotic fracture within 10 years.

Women younger than 65 years who have a risk for osteoporosis similar to that of a 65-year-old white woman with no other risk factors also should be screened. Risk factors for osteoporosis include advanced age, low body weight, and tobacco and alcohol use, as well as having a parent with an osteoporotic fracture. The FRAX (Fracture Risk Assessment) tool helps to estimate risk for osteoporosis; it is available at www.shef.ac.uk/FRAX.

The USPSTF concluded that there is not enough information to recommend either for or against osteoporosis screening in men.

What are the cautions related to these recommendations?

These recommendations do not apply to people with a previous osteoporotic fracture or those who have medical conditions or receive treatments that cause osteoporosis.





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