Screening for postmenopausal osteoporosis: A review of the evidence for the U.S. Preventive Services Task Force

Background: Although osteoporotic fractures present an enormous health burden, it is not clear whether screening to identify high-risk persons is appropriate. Purpose: To examine evidence on the benefits and harms of screening postmenopausal women for osteoporosis. Data Sources: MEDLINE (1966 to May 2001), HealthSTAR (1975 to May 2001), and Cochrane databases; reference lists; and experts. Study Selection: English-language abstracts that included original data about postmenopausal women and osteoporosis and addressed the effectiveness of risk factor assessment, bone density tests, or treatment were included. Data Extraction: Selected information about patient population, interventions, clinical end points, and study design were extracted, and a set of criteria was applied to evaluate study quality. Data Synthesis: No trials of the effectiveness of screening have been published. Instruments developed to assess clinical risk factors for low bone density or fractures have moderate to high sensitivity and low specificity. Among different bone density tests measured at various sites, bone density measured at the femoral neck by dual-energy x-ray absorptiometry is the best predictor of hip fracture. Women with low bone density have approximately a 40% to 50% reduction in fracture risk when treated with bisphosphonates. Conclusions: Population screening would be based on evidence that the risk for osteoporosis and fractures increases with age, that the short-term risk for fracture can be estimated by bone density tests and risk factors, and that fracture risk can be reduced with treatment. The role of risk factor assessment and different bone density techniques, frequency of screening, and identification of subgroups for which screening is most effective remain unclear.