Screening for osteoporosis: an update for the U.S. Preventive Services Task Force.

Area of Science:

• Osteoporosis research
• Preventive medicine
• Bone health

Background:

• Evidence on osteoporosis screening is updated since the 2002 U.S. Preventive Services Task Force recommendation.
• Focus on men and postmenopausal women without prior fractures.

Purpose of the Study:

• Evaluate osteoporosis screening effectiveness and harms in fracture reduction.
• Assess performance of risk-assessment tools and bone density tests.
• Determine optimal screening intervals and medication efficacy/harms for primary fracture prevention.

Main Methods:

• Searched Cochrane, MEDLINE, Web of Science, and reference lists (up to 2009).
• Included randomized controlled trials (RCTs) of screening/medications, performance studies of risk instruments, and systematic reviews/population studies of bone tests/medication harms.
• Abstracted data on populations, design, outcomes, and quality rated using established criteria.

Main Results:

• Risk-assessment instruments show modest prediction for low bone density and fractures; simple and complex tools perform similarly.
• Dual-energy X-ray absorptiometry (DXA) and calcaneal quantitative ultrasonography predict fractures, but have low correlation.
• Medications like bisphosphonates, parathyroid hormone, raloxifene, and estrogen reduce vertebral fractures in postmenopausal women; trials in men are lacking.
• Bisphosphonates show no consistent serious adverse events; raloxifene/estrogen increase thromboembolic events; estrogen has additional adverse effects.

Conclusions:

• Effective methods for identifying osteoporosis risk and medications for fracture reduction exist.
• Direct trials evaluating the effectiveness, harms, and optimal intervals of osteoporosis screening are notably absent, particularly for men.