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

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.

Osteoporosis is a condition in which bones become less dense and more fragile and bone fractures occur more easily. Since estrogen keeps bone dense, osteoporosis is especially common in women after menopause as estrogen levels drop. Estimates suggest that half of all postmenopausal women will suffer an osteoporosis-related fracture. Fractures can lead to substantial disability and health care expenses.

Two approaches can be taken to prevent fractures from osteoporosis. One is to promote measures that can prevent osteoporosis itself, such as adequate calcium and vitamin D intake, physical activity, and avoidance of tobacco and alcohol. Some drugs, such as estrogen and bisphosphonates, can also prevent osteoporosis, but they are not recommended for general use because of side effects and expense. The second approach is to screen for osteoporosis. Screening can identify women with low bone density, who are at highest risk for fracture and will benefit most from drugs that prevent fracture. Testing for osteoporosis involves measuring how dense bones are by using a special test called dual-energy x-ray absorptiometry (DEXA). Newer tests involve the use of other x-ray techniques and ultrasonography, but these tests have been studied less well.

The USPSTF reviewed published English-language research to measure the benefits and harms of screening for osteoporosis.

The authors found no studies that specifically looked at the effectiveness of screening for osteoporosis, so they considered information about the frequency of osteoporosis, the accuracy of the screening tests, and the effectiveness of treatments for osteoporosis. The authors found strong evidence that older age, weight under 70 kg (154 pounds), and not taking estrogen were risk factors for osteoporosis and related fractures. They found less strong evidence for the following risk factors: smoking, weight loss, family history of osteoporosis, low physical activity, high alcohol or caffeine intake, and low vitamin D and calcium intake. Surveys designed to screen for osteoporosis were moderately useful. Bone density measurement using DEXA is the best available test to identify women who are at risk for an osteoporosis-related fracture. Several available medications reduce the risk for fracture in women with low bone density, but evidence is currently strongest for bisphosphonates.

All women 65 years of age and older should be screened for osteoporosis by getting a bone density test. Women who have risk factors for osteoporosis should begin screening when they are 60 years of age. The screening test that has the most research to support it is DEXA obtained at the hip. It is unclear how frequently screening should occur. Screening more often than every 2 years is not likely to be helpful, and even longer intervals, such as 5 years, are probably adequate for women with normal bone density. Women with low bone density should receive treatment to prevent further decline in bone density and osteoporosis-related fractures.

The USPSTF may revise these recommendations as new information becomes available about osteoporosis risk factors, screening tests, and treatments.