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screening for osteoporosis

Use FRAX fracture risk assessment tool. Indications: - all women >= 65 years of age* [9] - women < 65 years with 10 year fracture risk (FRAX)* > 9.3% - DXA screening for osteoporosis in older women regardless of age if life expectancy is >= 2-5 years# - men > 50 years old with risk factor - glucocorticoids, androgen antagonists, HIV1 infection - HAART containing tenofovir disoproxil fumarate associated with greater decline in bone mineral density than other regimens [12] * 10 year risk of fracture (FRAX) for 65 year old white woman without any additional risk fractures is 9.3% [11] # treatment of osteoporosis with a bisphosphonate has an expected time-to-benefit of 1-2 years [7] Contraindications: - do not screen premenopausal women [4] Laboratory: - 25-hydroxyvitamin D in serum - National Academy of Medicine notes a lack of evidence as to benefits or effectiveness of screening for deficiency of vitamin D (SOE=D) Radiology: - bone mineral density of lumbar spine & femoral neck - USPSTF recommendations for bone-mineral density testing for a) screening all women beginning at age 65 & women < 65 if their 10-year fracture risk >= that of a woman> 65 without additional risk factors ~ 9% [8] (use WHO's FRAX tool to estimate fracture risk) [10] - USPSTF does not propose interval screening guidelines [5] - despite this, & evidence presented below, GRS11 implies 5 year screening interval for 70 yo woman with T-scores >= -1.0 [7] - it seems GRS11 is in error according to an accompanying explanation b) premature menopause without estrogen replacement implies high-risk [7] (does not appear to be in FRAX tool) - Medicare coverage of bone mineral density for men is dependent on the presence of specific risk factors (glucocorticoid use) [5] - for women with normal bone mineral density or mild osteopenia (T score > -1.50) a) >= 10 years between screenings [4] b) 15 year interval between screenings [3] - 5 year interval screening for women with moderate osteopenia (-1.50 > T score > -2.50) [3] - bone-mineral density T score <= -2.50 = osteoporosis [3] Management: - recommendations apply to all racial and ethnic groups - not enough evidence to determine whether routine screening is beneficial or harmful for men [1] - USPSTF does recommend screening men without risk factors for osteoporoisis [2] - National Osteoporosis Foundation does recommend screening for all men >= 70 years of age [5] - women at low risk for osteoporosis may be able to forgo bone mineral density screening [6] - Osteoporosis Self-Assessment Tool as effective as the FRAX (without bone mineral density) in identifying women at very low risk for osteoporosis [6]

Related

bone mineral density (BMD) FRAX fracture risk assessment tool osteoporosis

General

screening

References

  1. Journal Watch 22(22):158, 2002 U.S. Preventive Services Task Force. Screening for osteoporosis in postmenopausal women: recommendations and rationale. Ann Intern Med 137:526, 2002 PMID: 12230355 - Nelson HD et al, Screening for postmenopausal osteoporosis: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 137:529, 2002 PMID: 12230356 - Nelson HD et al. Screening for osteoporosis: an update for the U.S. Preventive Services Task Force. Ann Intern Med 2010 Jul 20; 153(2):99-111. Epub 2010 Jul 5. Review. PMID: 20621892. - U.S. Preventive Services Task Force Screening for Osteoporosis: U.S. Preventive Services Task Force Recommendation Statement Annals of Internal Medicine, January 17, 2011 PMID: 21242341 http://www.annals.org/content/early/2011/01/13/0003-4819-154-5-201103010-00307.full corresponding NGC guideline withdrawn Feb 2017
  2. Liu H, Paige NM, Goldzweig CL, Wong E, Zhou A, Suttorp MJ, Munjas B, Orwoll E, Shekelle P. Screening for osteoporosis in men: a systematic review for an American College of Physicians guideline. Ann Intern Med. 2008 May 6;148(9):685-701. Review. Summary for patients in: Ann Intern Med. 2008 May 6;148(9):I35. PMID: 18458282 http://www.annals.org/content/148/9/685.full - Qaseem A et al, Screening for osteoporosis in men: A clinical practice guideline from the American College of Physicians. Ann Intern Med. 2008 May 6;148(9):680-4 PMID: 18458281 http://www.annals.org/content/148/9/680.full
  3. Gourlay ML et al Bone-Density Testing Interval and Transition to Osteoporosis in Older Women N Engl J Med 2012; 366:225-233January 19, 2012 PMID: 22256806 http://www.nejm.org/doi/full/10.1056/NEJMoa1107142
  4. Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18. American College of Physicians, Philadelphia 2012, 2015, 2018.
  5. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  6. Pang WY, Inderjeeth CA. FRAX without bone mineral density versus osteoporosis self- assessment screening tool as predictors of osteoporosis in primary screening of individuals aged 70 and older. J Am Geriatr Soc. 2014;62:442-446 PMID: 24617899
  7. Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  8. Schnatz PF, Marakovits KA, Dubois M, O'Sullivan DM. Osteoporosis screening and treatment guidelines: are they being followed? Menopause. 2011 Oct;18(10):1072-8. PMID: 21753740
  9. U.S. Preventive Services Task Force (USPSTF) Draft Recommendation Statement. Nov 2017 Osteoporosis to Prevent Fractures: Screening. https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/osteoporosis-screening1 - U.S. Preventive Services Task Force (USPSTF) Draft Evidence Review. Nov 2017 Draft Evidence Review for Osteoporosis to Prevent Fractures: Screening. https://www.uspreventiveservicestaskforce.org/Page/Document/draft-evidence-review/osteoporosis-screening1
  10. US Preventive Services Task Force Curry SJ et al. Screening for Osteoporosis to Prevent Fractures. US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319(24):2521-2531 PMID: 29946735 https://jamanetwork.com/journals/jama/fullarticle/2685995 - Viswanathan M, Reddy S, Berkman N et al Screening to Prevent Osteoporotic Fractures. Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2018;319(24):2532-2551. PMID: 29946734 https://jamanetwork.com/journals/jama/fullarticle/2685994 - Cauley JA Screening for Osteoporosis. JAMA. 2018;319(24):2483-2485 PMID: 29946707 https://jamanetwork.com/journals/jama/fullarticle/2685965 - Gourlay ML. Osteoporosis Screening - 2 Steps May Be Too Much for Women Younger Than 65 Years. JAMA Intern Med. Published online June 26, 2018. PMID: 29946684 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2684639
  11. Talebraza S et al Geriatrics Evaluation & Management Tools American Geriatrics Society. 2021 https://geriatricscareonline.org/ProductAbstract/geriatrics-evaluation-management-tools/B007/
  12. NEJM Knowledge+ Complex Medical Care