This series of fact sheets is based on the work of the U.S. Preventive Services Task Force (USPSTF). The USPSTF systematically reviews the evidence of effectiveness of a wide range of clinical preventive services—including screening, counseling, and chemoprevention (the use of medication to prevent diseases)—to develop recommendations for preventive care in the primary care setting.
This fact sheet presents highlights of USPSTF recommendations on this topic and should not be used to make treatment or policy decisions. More detailed information on this subject is available from the USPSTF and the Annals of Internal Medicine 2002;137:526-41.
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Osteoporosis is a condition marked by thinning and weakening of bones and can lead to fractures, loss of height due to compression of the bones in the spine, and pain. Currently, osteoporosis is most commonly diagnosed by finding an abnormal result on x-rays that measure bone mineral density.
Osteoporosis and fracture are most common in older women and are due to gradual loss of bone after menopause. Fifty percent of all women who live to be 85 years of age will have an osteoporosis-related fracture during their lives; 25 percent of these women will develop a deformity of the spine, and 15 percent will fracture a hip. Screening women at risk for osteoporosis can lead to early detection and treatment, thus preventing fractures.
Screening and treating women at risk for osteoporosis can help prevent fractures.
Women are at greater risk for osteoporosis and fracture than men are because women's bones are less dense than men's bones. Risk for osteoporosis increases steadily and substantially with age. Women 65 or older are at greatest risk. Lower body weight is also consistently associated with osteoporosis, but to a lesser degree than age. Women weighing less than 132 pounds are at greatest risk; women 60 and older who weigh less than 154 pounds are at increased risk.
Low weight, no current use of estrogen, and age are incorporated into the 3-item Osteoporosis Risk Assessment Instrument (ORAI), which helps clinicians identify women younger than 65 who should be screened: http://www.osteoed.org/faqs.php
The USPSTF recommends that women 65 and older be screened routinely for osteoporosis. For women at high risk for fractures, the USPSTF recommends that screening begin at age 60.
The USPSTF makes no recommendation for or against screening women aged 60-64 for osteoporosis if they are not at high risk for this condition. The Task Force makes no recommendation for or against screening women younger than 60.
Women aged 65 and older should be screened routinely for osteoporosis.
Screening tests for bone mineral density can identify women at increased risk for a variety of fractures; these women then can be treated with medications to reduce that risk. Dual-energy x-ray absorptiometry (DXA) of the hip is the best predictor of hip fracture. Using DXA to measure bone density of the hand, wrist, forearm, and heel also appears to detect women who are at increased risk for fracture.
Other tests to measure bone mineral density include ultrasound, radiographic absorptiometry, single energy x-ray, absorptiometry, peripheral dual-energy x-ray absorptiometry, and peripheral quantitative computed tomography.
Biphosphonates, such as alendronate and risendronate; selective estrogen-receptor modulators (SERMs), such as raloxifene; calcitonin; and estrogen can improve bone density and reduce risk for fractures. Each of these treatments has potential benefits and harms. Clinicians should discuss these with their patients and help them decide which treatment is best for them.
Clinicians should discuss the potential benefits and harms of each treatment with their patients.
The previous Task Force found insufficient evidence to recommend for or against routine screening for osteoporosis in postmenopausal women. At that time, only estrogen was proven to reduce fractures in healthy women, but it was not clear that bone density screening was necessary to make decisions about hormone therapy.
Since those recommendations were released in 1996, prospective trials have demonstrated that biphosphonates and SERMs reduce the risk for fracture in women who have osteoporosis but who haven't already had a fracture.
The current USPSTF recommendation on osteoporosis screening in postmenopausal women is similar to the recommendations of 10 other major groups, including:
For more information on osteoporosis screening and treatment, contact the following organizations:
healthfinder®
http://www.healthfinder.gov
National Institutes of Health
http://www.nih.gov
Members of the USPSTF represent the fields of family medicine, gerontology, obstetrics-gynecology, pediatrics, nursing, prevention research, and psychology. Members of the USPSTF are:
Alfred O. Berg, M.D., M.P.H., Chair
Janet D. Allan, Ph.D., R.N., C.S., Vice-chair
Paul S. Frame, M.D.
Charles J. Homer, M.D., M.P.H.
Mark S. Johnson, M.D., M.P.H.
Jonathan D. Klein, M.D., M.P.H.
Tracy A. Lieu, M.D., M.P.H.
C. Tracy Orleans, Ph.D.
Jeffrey F. Peipert, M.D., M.P.H.
Nola J. Pender, Ph.D., R.N.
Albert L. Siu, M.D., M.S.P.H.
Steven M. Teutsch, M.D., M.P.H.
Carolyn Westhoff, M.D., M.Sc.
Steven H. Woolf, M.D., M.P.H.
AHRQ Publication No. APPIP02-0025
Current as of September 2002
Internet Citation:
Screening for Osteoporosis in Postmenopausal Women. What's New from the USPSTF? AHRQ Publication No. APPIP02-0025, September 2002. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/3rduspstf/osteoporosis/osteowh.htm
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