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New Recommendations for Osteoporosis Screening

At-Risk Postmenopausal Women Should Get Bone Density Measured

What the Guidelines Update continued...

The new guidelines drop that age ceiling, saying instead that postmenopausal women of any age should be checked if they have individual risk factors that give them 9% to 10% risk of breaking a bone in the next decade, which is roughly the same risk as a 65-year-old white woman with no additional risk factors.

The panel used the freely available FRAX risk assessment tool, which was developed by the World Health Organization, to determine its risk equivalents.

The panel also found substantial evidence that drug therapies, including treatment with bisphosphonates, hormones, and SERMs, decreased the risk of fractures in women who’d never broken a bone but who are at increased risk of osteoporosis-related fractures.

Lingering Uncertainty About the Benefits of Measuring Bone Mass

Despite the new guidelines, the scientists who reviewed the evidence behind them note that there are no controlled studies that have ever looked at whether screening reduces fractures or their associated health consequences.

“We really don’t have studies that do that big-picture look,” says Heidi Nelson, MD, MPH, a professor of medical informatics at Oregon Health and Science University in Portland, who led the review.

Instead, she says, the panel had to piece together a chain of indirect evidence of benefit from trials that looked at the effects of drug treatments, for example.

For men, the panel found that a distinct lack of evidence.

“Actual trials of the medications used to treat low bone mass are really lacking in men,” Nelson says.

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