Screening for Osteoporosis to Prevent Fractures: A Systematic Evidence Review for the US Preventive Services Task
Leila C Kahwati1,2, Christine E Kistler3, Graham Booth1,2
1RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center.
Osteoporosis screening in older, higher-risk women reduced hip and major fractures. Pharmacotherapy with bisphosphonates or denosumab also lowered fracture risk without significant harms.
Area of Science:
- Gerontology and Preventive Medicine
- Bone Health and Osteoporosis Research
Background:
- Fragility fractures lead to substantial morbidity and healthcare costs.
- Effective osteoporosis screening strategies are crucial for early detection and intervention.
Purpose of the Study:
- To review the evidence on osteoporosis screening effectiveness for the US Preventive Services Task Force.
- To evaluate the accuracy of risk assessment tools and the efficacy of osteoporosis pharmacotherapy.
Main Methods:
- Systematic review and meta-analysis of randomized clinical trials (RCTs) and systematic reviews.
- Included studies on screening, osteoporosis pharmacotherapy, and predictive/diagnostic accuracy.
- Data sources included PubMed, Embase, Cochrane Library, and trial registries up to January 2024.
Main Results:
- Screening in older, higher-risk women showed a small absolute risk reduction in hip and major osteoporotic fractures.
- Two-stage screening (risk assessment tool + BMD) was evaluated.
- Bisphosphonates and denosumab demonstrated significant reductions in hip fracture risk compared to placebo, with no meaningful increase in adverse events.
Conclusions:
- Screening higher-risk women aged 65+ is associated with a modest reduction in fracture incidence.
- Current evidence does not support screening with bone mineral density (BMD) alone or in men/younger women.
- Pharmacological treatments like bisphosphonates and denosumab are effective for reducing fractures in osteoporosis patients.
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