Screening
The NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy states that optimal screening guidelines have not been determined for populations; it recommends that diagnostic testing of people be based on risk factors.[2]
The American College of Obstetrics and Gynecology (ACOG) recommends screening for osteoporosis with dual-energy x-ray absorptiometry (DXA) in postmenopausal patients aged ≥65 years. DXA measurement of the hip (femoral neck) and lumbar spine provide the most accurate measurements of bone mineral density (BMD).[31] For patients younger than 65 years, the ACOG recommends screening for osteoporosis for patients who are at increased risk of osteoporosis, as determined by a formal clinical risk assessment tool.[31] For patients whose screening results are near treatment thresholds, or those with significant changes in risk factors, repeat BMD testing is recommended no sooner than 2 years after initial screening.
The US Preventive Services Task Force (USPSTF) recommends that women aged 65 years and older and for postmenopausal women under 65 years of age who are at increased risk for an osteoporotic fracture. The USPSTF makes no recommendation for an upper age limit at which screening should not be performed.[88]
The American College of Preventive Medicine recommends that all adult patients (aged 50 years and older) should be evaluated for osteoporosis risk factors. BMD testing is recommended in women 65 years and older and in men 70 years and older. In younger postmenopausal women or in men aged 50-69 years, BMD should be measured if at least 1 major or 2 minor risk factors for osteoporosis are present.[89]
The Canadian Task Force on Preventive Health Care recommends screening postmenopausal women aged ≥65 years using FRAX without BMD; they recommend performing DXA and recalculating FRAX with BMD if preventive pharmacotherapy is being considered. Based on low-certainty evidence, they recommend against screening for women aged 40-64 years and men aged ≥40 years.[90]
One systematic review and meta-analysis demonstrated a significant reduction of major osteoporotic fractures and hip fractures after screening using fracture risk assessment and bone densitometry, compared with usual care.[91]
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