Association between screening for osteoporosis and the incidence of hip fracture

Ann Intern Med. 2005 Feb 1;142(3):173-81. doi: 10.7326/0003-4819-142-3-200502010-00007.


Background: Because direct evidence for the effectiveness of screening is lacking, guidelines disagree on whether people should be screened for osteoporosis.

Objective: To determine whether population-based screening for osteoporosis in older adults is associated with fewer incident hip fractures than usual medical care.

Design: Nonconcurrent cohort study.

Setting: Population-based cohort enrolled in the Cardiovascular Health Study (CHS) from 4 states (California, Pennsylvania, Maryland, and North Carolina).

Patients: 3107 adults 65 years of age and older who attended their CHS study visits in 1994-1995.

Measurements: 31 participant characteristics (including demographic characteristics, medical histories, medications, and physical examination findings) and incident hip fractures over 6 years of follow-up.

Intervention: Bone density scans (dual-energy x-ray absorptiometry [DEXA] at the hip) for participants in California and Pennsylvania (n = 1422) and usual care for participants in Maryland and North Carolina (n = 1685).

Results: The incidence of hip fractures per 1000 person-years was 4.8 in the screened group and 8.2 in the usual care group. Screening was associated with a statistically significant lower hazard of hip fracture than usual care after adjustment for sex and propensity to be screened (Cox proportional hazard ratio, 0.64 [95% CI, 0.41 to 0.99]).

Limitations: The mechanism of the association was unclear. A small unmeasured confounder that decreased the hazard of hip fracture could diminish or erase the observed association.

Conclusions: Use of hip DEXA scans to screen for osteoporosis in older adults was associated with 36% fewer incident hip fractures over 6 years compared with usual medical care. Further research is needed to explore the mechanism of this association.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Absorptiometry, Photon
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Female
  • Hip Fractures / epidemiology*
  • Hip Fractures / prevention & control*
  • Humans
  • Incidence
  • Male
  • Mass Screening* / methods
  • Osteoporosis / epidemiology*
  • Risk Factors
  • Sensitivity and Specificity