Screening for Osteoporosis to Prevent Fractures

Abstract

IMPORTANCE By 2020, approximately 12.3 million individuals in the United States older than 50 years are expected to have osteoporosis. Osteoporotic fractures, particularly hip fractures, are associated with limitations in ambulation, chronic pain and disability, loss of independence, and decreased quality of life, and 21% to 30% of patients who experience a hip fracture die within 1 year. The prevalence of primary osteoporosis (ie, osteoporosis without underlying disease) increases with age and differs by race/ethnicity. With the aging of the US population, the potential preventable burden is likely to increase in future years.OBJECTIVE To update the 2011 US Preventive Services Task Force (USPSTF) recommendation on screening for osteoporosis. EVIDENCE REVIEWThe USPSTF reviewed the evidence on screening for and treatment of osteoporotic fractures in men and women, as well as risk assessment tools, screening intervals, and efficacy of screening and treatment in subgroups. The screening population was postmenopausal women and older men with no known previous osteoporotic fractures and no known comorbid conditions or medication use associated with secondary osteoporosis.FINDINGS The USPSTF found convincing evidence that bone measurement tests are accurate for detecting osteoporosis and predicting osteoporotic fractures in women and men. The USPSTF found adequate evidence that clinical risk assessment tools are moderately accurate in identifying risk of osteoporosis and osteoporotic fractures. The USPSTF found convincing evidence that drug therapies reduce subsequent fracture rates in postmenopausal women. The USPSTF found that the evidence is inadequate to assess the effectiveness of drug therapies in reducing subsequent fracture rates in men without previous fractures. CONCLUSIONS AND RECOMMENDATIONThe USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 years and older. (B recommendation) The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in postmenopausal women younger than 65 years at increased risk of osteoporosis, as determined by a formal clinical risk assessment tool. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures in men. (I statement)

Development of a polygenic risk score to improve screening for fracture risk: A genetic risk prediction study

“…In the absence of an international consensus on fracture risk screening [2,4,5,30], we chose to use the assessment and management clinical algorithm developed by NOGG [3], since a screening program similar to the NOGG screening strategy is supported by randomized controlled trial evidence [9]. The NOGG screening strategy uses 10-year absolute probability of fracture as calculated by FRAX and suggests treatment or reassurance based on thresholds of risk, which are age dependent and consider competing risks.…”

“…Osteoporosis is a common and costly disease that results in an increased predisposition to fractures [1]. Many guidelines [2][3][4][5][6] aimed at the prevention of osteoporosis-related fractures incorporate the Fracture Risk Assessment Tool (FRAX) [7,8], a validated method to risk stratify individuals for treatment by assessing their 10-year probability of major osteoporotic fracture. Guidelines vary widely, but often recommend a staged process where individuals are first assessed with a clinical-risk-factor-based FRAX (CRF-FRAX), and those at increased risk of fracture are then additionally characterized with a more expensive bone mineral density (BMD)-based FRAX (BMD-FRAX) score.…”

Women’s health 2019: Osteoporosis, breast cancer, contraception, and hormone therapy

“…treat osteoporosis early to prevent fractures. 2 Available evidence on screening and treatment in women and men were reviewed with the intention of updating the 2011 USPSTF recommendations. The review also evaluated risk assessment tools, screening intervals, and effi cacy of screening and treatment in various subpopulations.…”

“…This is equivalent to the fracture risk of a 65-year-old white woman with no major risk factors for fracture (grade B recommendation-high certainty that the benefi t is moderate, or moderate certainty that the benefi t is moderate to substantial). 2…”

Can Dietary Intake of Vitamin C-Oriented Foods Reduce the Risk of Osteoporosis, Fracture, and BMD Loss? Systematic Review With Meta-Analyses of Recent Studies

“…Vitamin Coriented foods comprise one of the most important components of the diet and have been reported to exert many potential health benefits, because they are rich in vitamins, fiber, phytochemicals, and minerals (6). Several studies have found that DIVCF significantly lowers the risk of breast cancer, hypertension, metabolic syndrome, type 2 diabetes mellitus, depression, inflammatory bowel disease, and all-cause mortality (7,8). Antioxidants and anti-inflammatory components from such diets are hypothesized to play a vital role in the protective effects against osteoporosis (9).…”