New Recommendations for Osteoporosis Screening

At-Risk Postmenopausal Women Should Get Bone Density Measured

By Brenda Goodman
WebMD Health News

Reviewed by Laura J. Martin, MD

Jan. 19, 2011 -- An influential panel of experts has issued new guidelines for osteoporosis screening, recommending for the first time that women younger than 60 get bone density scans if they have risk factors that increase the likelihood that they could experience a fracture within the next 10 years.

The new recommendations come from the U.S. Preventive Services Task Force (USPSTF), an independent panel of experts commissioned by the government to study the evidence behind routine health screens like Pap smears and mammograms, and they carry special weight.

Last July, the White House issued new rules requiring insurance companies to provide tests recommended by the USPSTF at no charge.

That means postmenopausal women with other risk factors for osteoporosis such as having parents who fractured bones, being white, a history of smoking, alcohol abuse, or a slender frame could now qualify for bone scans without co-pays or deductibles.

The most commonly used methods for measuring bone density are dual-energy X-ray absorptiometry, or DEXA, scans of the hip and spine, and ultrasound of the heel.

The panel maintained its recommendation that all women age 65 and over should get bone density testing, even if they have no other risk factors for the disease, which causes bone to break down faster than it rebuilds. Over time, bones become weaker and more likely to break under even normal stresses and strains, like minor falls.

According to the National Osteoporosis Foundation, half of all postmenopausal women and about one-quarter of men will break a bone because of osteoporosis in their lifetimes.

The panel offered no recommendations for osteoporosis screening in men, however, citing a lack of evidence of either benefit or harm.

"That's significant," contends task force chair Ned Calonge, MD, who also head the nonprofit The Colorado Trust. "It means there's a research gap, so we made that statement as a placeholder and a request for more research."

The report of the task force is published in the Jan. 18 issue of the Annals of Internal Medicine.

What the Guidelines Update

Previous guidelines issued by the panel in 2002 said women between the ages of 60 to 64 should get bone scans only if other factors put them at increased risk.

The new guidelines drop that age ceiling, saying instead that postmenopausal women of any age should be checked if they have individual risk factors that give them 9% to 10% risk of breaking a bone in the next decade, which is roughly the same risk as a 65-year-old white woman with no additional risk factors.

The panel used the freely available FRAX risk assessment tool, which was developed by the World Health Organization, to determine its risk equivalents.

The panel also found substantial evidence that drug therapies, including treatment with bisphosphonates, hormones, and SERMs, decreased the risk of fractures in women who'd never broken a bone but who are at increased risk of osteoporosis-related fractures.

Lingering Uncertainty About the Benefits of Measuring Bone Mass

Despite the new guidelines, the scientists who reviewed the evidence behind them note that there are no controlled studies that have ever looked at whether screening reduces fractures or their associated health consequences.

"We really don't have studies that do that big-picture look," says Heidi Nelson, MD, MPH, a professor of medical informatics at Oregon Health and Science University in Portland, who led the review.

Instead, she says, the panel had to piece together a chain of indirect evidence of benefit from trials that looked at the effects of drug treatments, for example.

For men, the panel found that a distinct lack of evidence.

"Actual trials of the medications used to treat low bone mass are really lacking in men," Nelson says.

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SOURCES: Ned Calonge, MD, chair, U.S. Preventive Services Task Force.Heidi Nelson, MD, MPH, Oregon Health and Science University, Portland.Annals of Internal Medicine, Jan. 18, 2010.

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