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Osteoporosis screening guidelines updated for older and younger women

Kathleen Blanchard's picture

Osteoporosis screening should be performed routinely on all women over age 65, suggests new guidelines.

In a first recommendation since 2002, the U.S. Preventive Services Task Force (USPSTF) also recommends routine osteoporosis screening for younger white women with increased risk factors for bone loss that leads to osteoporosis that include parental family history of fractures, low body mass index, tobacco smoking and alcohol use.

The decision to update osteoporosis screening guidelines comes from evidence that white women are at higher risk for the disease than other ethnic groups. Given the effectiveness of treatment, the USPSTF did not include a cut-off point for older women who can benefit from bone-density exams that noninvasively detect loss of bone mass early.

Osteoporosis risk factors increase with age. The task force did not make any recommendations for screening men for the disease, due to insufficient evidence of the benefits.

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“As the number of people over the age of 65 in the United States increases, osteoporosis screening continues to be important in detecting women at risk who will benefit from treatment to prevent fractures,” said Task Force Chair Ned Calonge, M.D.,president and CEO of The Colorado Trust. “Clinicians also should talk to their younger patients to learn if they have risk factors that mean they should be screened.”

The USPSTF does recommend drug therapy for post-menopausal women with osteoporosis without previous fractures. Recommended treatment options include bisphosphonates, parathyroid hormone, raloxifene and estrogen to reduce the chances of fractures, hospitalization and potential for long-term disability.

The agency classifies preventive services as "A” and “B” (recommended), “C” (no recommendation for routinely providing a service), “D” (recommending against) or “I” (insufficient evidence to make a decision).

Loss of bone density can lead to fractures. Estrogen decline from menopause puts all women at risk for the painful condition as does advancing age.

The new recommendations for screening women over age 65 on a regular basis, as well as younger women with risk factors, comes from the U.S. Preventive Services Task Force who independently review scientific evidence related to patient outcomes for preventive screening, but do not take cost into consideration. The guidelines became official today and can be viewed at the USPSTF website.