Effectiveness and cost-effectiveness of targeted and population screening for osteoporosis in women: scoping review

Osteoporosis is a systemic skeletal disorder characterised by bone tissue deterioration, leading to reduced bone density and increased susceptibility to fractures. Osteoporosis screening is the process of identifying people with an increased risk of osteoporosis by using risk assessment tools or medical imaging. The National Institute for Health and Care Excellence recommends opportunistic risk assessment in women over 65 years or under 65 years with risk factors, though this guideline was last updated in 2017. Regular surveillance of the available evidence is warranted to gauge the volume and type of evidence published on key issues relating to population-based and targeted screening for osteoporosis.

To identify and review the volume and type of evidence on effectiveness and cost-effectiveness of population-based and targeted osteoporosis screening in women and to explore the consideration of health equity in the evidence base.

Two information specialists developed the search strategy in MEDLINE (via Ovid) and translated it to 10 other databases. The title and abstract then full text of each record were screened by two independent reviewers. Disagreements were resolved through discussion. Records found through supplementary searches were single-screened as were reference lists of relevant guidelines identified. One reviewer completed data extraction of included studies, with a second reviewer checking the accuracy.

Included studies were required to be experimental designs, systematic reviews or cost-effectiveness studies with a standard care comparator. Populations of interest were women over 65 years and women below 65 years with osteoporosis risk factors.

Any population or targeted screening intervention involving any combination of risk assessment and dual energy X-ray absorptiometry scan designed to identify women with, or at risk for, osteoporosis.

Outcomes related to osteoporosis prevention (osteoporotic fractures, all-cause fractures and mortality), possible screening harms and cost-effectiveness.

Searches were conducted in 11 databases and were supplemented by forward and backward citation searching.

Study characteristics and equity considerations were tabulated and narratively described.

The 19 included studies consisted of 3 randomised controlled trials with 9 sibling papers, 1 non-concurrent cohort study and 6 reviews. The primary studies generally included women 65 years old and older, with interventions involving several risk assessment and screening methods. Most reviews investigated the general population and included either bone mineral density measurement or clinical risk assessment for screening. Studies mainly reported fracture outcomes, with some quality-of-life and cost-effectiveness measures. Equity-relevant features analysed by studies included education, relationships, income and age.

Our inclusion criteria may have excluded some evidence discussed by other related reviews.

Evidence on the effectiveness and cost-effectiveness of osteoporosis screening is limited, with reviews mainly drawing conclusions from the same few primary studies currently available. The evidence base lacks consideration of equity-related characteristics.

High-quality trial evidence is required, particularly for targeted screening. Equity characteristics should be addressed in future work.

The review aims to identify gaps in the current evidence base for targeted and population osteoporosis screening to inform future research and healthcare policy-makers' decisions.

This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Evidence Synthesis programme as award number NIHR169162.