Jennifer Lovejoy, Arivale Chief Science Officer, PhD
Estimates show that by 2020, approximately 12.3 million Americans over 50 are expected to have osteoporosis. Fractures due to osteoporosis are associated with decreased quality of life and increased mortality risk. And as the US population gets older, the burden from this disease is likely to increase.
Screening tools, such as bone measurement tests and clinical risk assessments, are helpful in assessing one’s risk for osteoporosis. There’s evidence that treatment with a bone-preserving or bone-building drug is beneficial when a bone density test reveals a level of bone loss.
With hopes of reducing the burden of osteoporosis, the US Preventative Services Task Force in 2011 recommended screening for osteoporosis in women 65 years or older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors. The USPSTF concluded there was insufficient evidence in men to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures.
In June 2018, with the objective to update these recommendations, the USPSTF reviewed new evidence about the benefits and harms of screening and treatment to prevent osteoporotic fractures in American adults. Its findings were published in JAMA and covered by the New York Times.
The USPSTF reviewed 168 studies that met certain quality criteria.
It found convincing evidence that bone measurement tests, such as central DXA (a non-invasive x-ray technology that measures bone mineral density), are accurate for detecting osteoporosis and predicting osteoporotic fractures in both women and men.
In addition, it found evidence that clinical risk assessment tools, such as the FRAX tool (a questionnaire that assesses a person’s 10-year risk of fracture), are moderately accurate in identifying risk of osteoporosis and osteoporotic fractures.
Furthermore, the USPSTF found convincing evidence that drug therapies reduce subsequent fracture rates in postmenopausal women. However, there’s a lack of evidence to assess the effectiveness of drug therapies in reducing fracture rates in men without previous fractures.
Based on these findings, the USPSTF released new guidelines on screening for osteoporosis.
Instead of nondescript screening for osteoporosis in women 65 years or older, it’s now specifically bone measurement testing that is recommended. For women younger than 65, bone measurement testing is only recommended if you are postmenopausal (not a criteria in the previous recommendation) and at increased risk of osteoporosis (as defined by a clinical risk assessment tool).
For men, the USPSTF didn’t change its previous recommendation that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures.
As with any study, there were limitations to the USPSTF’s review.
First, the studies included in the review differed with respect to some factors, such as length of study follow-up and baseline bone mineral density of participants. Thus, combining some of these studies to make recommendations may not be ideal (in a sense, you should combine like with like).
Second, the evidence is lacking on screening in men and premenopausal women and on long-term harms of screening and treatment.
Another limitation is that only prescription drug therapies were examined in regard to reducing fracture rates; the study did not examine other interventions that might reduce the risk of osteoporotic fractures, such as exercise, vitamin supplementations, and dietary interventions.
But, those limitations don’t reduce the importance of being screened for osteoporosis – and doing what you can to keep your bones healthy as you age. Ensuring you’re getting adequate calcium and vitamin D, focusing exercise on balance and flexibility, and avoiding excessive caffeine intake may reduce your risk of developing osteoporosis or suffering osteoporosis-related fractures.
[Arivale Hot Topics address health stories currently in the news. The Arivale Clinical Team’s commentary on these news articles is not a review of the scientific evidence, nor an endorsement of a specific study, and is not meant as official medical opinion.]