Background: Osteoporosis and related fractures are common in older individuals and lead to premature mortality, loss of function and independence, reduced quality of life, and high costs. Despite its importance, osteoporosis is under detected in the United States. This review updates evidence since the 2002 U.S. Preventive Services Task Force recommendation on osteoporosis screening.
Purpose: To determine the effectiveness and harms of osteoporosis screening in reducing fractures for men and postmenopausal women without known previous fractures; the performance of risk-assessment instruments and bone measurement tests in identifying persons with osteoporosis; optimal screening intervals; and efficacy and harms of medications to reduce primary fractures.
Data Sources: Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the 4th Quarter of 2009), MEDLINE (January 2001 to December 2009), reference lists, and Web of Science searches.
Study Selection: Randomized, controlled trials of screening or medications with fracture outcomes published in English; performance studies of validated risk-assessment instruments; and systematic reviews and population-based studies of bone measurement tests or medication harms.
Data Extraction: Data on patient populations, study design, analysis, follow-up, and results were abstracted; study quality was rated by using criteria developed by the USPSTF.
Data Synthesis: Risk-assessment instruments are modest predictors of low bone density (area under the curve, 0.13 to 0.87; 14 instruments) and fractures (area under the curve, 0.48 to 0.89; 11 instruments); simple and complex instruments perform similarly. Dual-energy x-ray absorptiometry predicts fractures similarly for men and women; calcaneal quantitative ultrasonography also predicts fractures, but correlation with dual-energy x-ray absorptiometry is low. Repeating a bone density measurement up to 8 years after an initial measurement does not significantly improve predictive performance for fracture outcomes. For postmenopausal women, bisphosphonates, parathyroid hormone, raloxifene, and estrogen reduce primary vertebral fractures; bisphosphonates reduce primary nonvertebral fractures in sensitivity analysis. Medications are effective for bone density T-scores of −2.5 or less for women without previous known fractures. Primary prevention trials are lacking for men. Bisphosphonates are not consistently associated with serious adverse events; raloxifene and estrogen increase thromboembolic events; estrogen increases stroke; and estrogen with progestin increases coronary heart disease and breast cancer.
Limitations: Trials of screening with fracture outcomes, screening intervals, and medications to reduce primary fractures, particularly enrolling men, are lacking.
Conclusions: Although methods to identify risk for osteoporotic fractures are available and mediations to reduce fractures are effective, no trials directly evaluate screening effectiveness, harms, and intervals.
Screening for Osteoporosis: An Update for the U.S. Preventive Services Task ForceHD Nelson et al. Ann Intern Med 153 (2), 99-111. PMID 20621892. - ReviewAlthough methods to identify risk for osteoporotic fractures are available and medications to reduce fractures are effective, no trials directly evaluate screening effect …
Screening to Prevent Osteoporotic Fractures: An Evidence Review for the U.S. Preventive Services Task Force [Internet]M Viswanathan et al. PMID 30325616. - ReviewEvidence from one trial of screening to prevent osteoporotic fractures suggests a reduction in hip fractures. The accuracy of clinical risk assessment tools for identifyi …
Medication Use for the Risk Reduction of Primary Breast Cancer in Women: A Systematic Review for the U.S. Preventive Services Task Force [Internet]HD Nelson et al. PMID 31509365. - ReviewTamoxifen, raloxifene, and the aromatase inhibitors exemestane and anastrozole reduce invasive breast cancer in women without preexisting breast cancer, but also cause ad …
Screening for Cognitive Impairment in Older Adults: An Evidence Update for the U.S. Preventive Services Task Force [Internet]JS Lin et al. PMID 24354019. - ReviewWe found no trial evidence that examined the effect of screening for cognitive impairment on patient, caregiver, or clinician decisionmaking or important patient, caregiv …
Screening to Prevent Osteoporotic Fractures: Updated Evidence Report and Systematic Review for the US Preventive Services Task ForceM Viswanathan et al. JAMA 319 (24), 2532-2551. PMID 29946734. - ReviewIn women, screening to prevent osteoporotic fractures may reduce hip fractures, and treatment reduced the risk of vertebral and nonvertebral fractures; there was not cons …
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Osteoporosis as an Independent Risk Factor for Silent Brain Infarction and White Matter Changes in Men and Women: The PRESENT ProjectYK Minn et al. Osteoporos Int 25 (10), 2465-9. PMID 25011984.Severe bone mass loss may be an independent risk factor for brain WMC/SI in men and women. Low BMD may cause brain WMC/SI in the step that leads to stroke. Although there …