Q&A

Densitometry identifies women in whom treatment will reduce fracture risk

Author and Disclosure Information

  • BACKGROUND: Does osteoporosis screening decrease fracture risk in postmenopausal women? Osteoporosis results in 1.3 million fractures annually in the US.2 Of the approximately 25 million American women with osteoporosis, 8 million have had a documented fracture.
  • POPULATION STUDIED: The authors examined all information available from English-language abstracts that contained original data about postmenopausal women and osteoporosis and addressed screening or the effectiveness of risk factor assessment, bone density testing, or treatment.
  • STUDY DESIGN AND VALIDITY: This systematic review included relevant studies identified from multiple searches of MEDLINE (1966 to May 2001), HealthSTAR (1975 to May 2001), and Cochrane databases; reference lists of systematic reviews; and experts. Two reviewers read each abstract to determine its eligibility. The authors highlighted studies that were applicable to current practice standards, had high-quality internal validity ratings, and were most generalizable to the US population of postmenopausal women under consideration for screening. The authors excluded studies of primary prevention of osteoporosis and secondary causes of osteoporosis.
  • OUTCOMES MEASURED: A radiographically verified, nontraumatic fracture was the primary outcome used in the evaluation of therapeutic trials included in this review.
  • RESULTS: The authors were unable to identify studies concerning the effectiveness of screening in reducing osteoporotic fractures. The authors reviewed articles on risk factor assessment, bone density tests, and osteoporosis treatment with bisphosphonates. They then created an outcomes table based on assumptions from the reviewed articles to estimate the effect of screening 10,000 postmenopausal women for osteoporosis on reducing hip and vertebral fractures.


 

PRACTICE RECOMMENDATIONS

Despite lack of research on the effectiveness of osteoporosis screening to reduce fractures, there is sufficient evidence that bone density measurements accurately predict short-term fracture risk and that treating asymptomatic women with osteoporosis reduces fracture risk.

According to this report, a reasonable recommendation is to screen all women older than 65 years and postmenopausal women younger than 65 years who have low weight (or body mass index) or who have never used hormone replacement therapy.1

The US Preventive Services Task Force noted that the optimal screening frequency has not been studied, but suggested a frequency of not more than every 2 years for older women or every 5 years for younger postmenopausal women. Also of note: other sources, notably the bisphosphonates package labeling, advise against monitoring therapy with repeated dual-energy x-ray absorptiometry or other methods.

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