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The new USPSTF osteoporosis screening recommendations are out. Find out what's new and how much you know.
The US Preventive Task Force (USPSTF) last released recommendations on screening for osteoporosis in 2011. The 2018 update is based on a review of evidence on screening for and treatment of osteoporotic fractures in men and women, risk assessment tools, screening intervals, and efficacy of treatment.
How much has changed vs stayed the same? Find out what you know with our short, 5-question quiz.
Answer: C. 65 and older. According to the 2018 USPSTF final recommendations, all women aged 65 and older should have osteoporosis screening with bone measurement testing. After review of the evidence, the USPSTF found convincing evidence that bone measurement tests accurately detect osteoporosis and predict osteoporotic fractures.
Answer: C. Nulliparous. The USPSTF lists the following risk factors for osteoporosis in women younger than age 65: postmenopausal, parental history of hip fracture, smoking, excessive alcohol consumption, low body weight, long-term corticosteroid use, previous fractures, and falls in the last year. The USPSTF recommends that women younger than age 65 who are at increased risk of osteoporotic fractures (as determined by clinical risk assessment tools such as FRAX, Garvan Institute, SCORE, ORAI, OSIRIS, or OST) should be screened for osteoporosis using bone measurement testing. The USPSTF found adequate evidence that screening can detect osteoporosis in such women, and that the benefit of treatment in preventing fractures is moderate.
Answer: B. False. The USPSTF has not changed its previous 2011 recommendation regarding osteoporosis screening in men, which is no recommendation. The USPSTF found there is still inadequate evidence about the benefits and harms of treating osteoporosis detected through screening in men in order to decrease the risk of osteoporotic fractures.
Answer: D. None of the above. The USPSTF did not make a formal recommendation about the preferred manner of bone measurement testing, although it did mention that bone measurement techniques have varying degrees of accuracy. The USPSTF mentions that central DXA scanning is the established standard for diagnosing osteoporosis and guiding treatment decisions. The USPSTF also mentioned that screening with peripheral DXA may increase access to osteoporosis screening, and identified two studies that suggest peripheral DXA scanning at the calcaneus may be less accurate vs central DXA scanning. QUS at peripheral sites has the advantage of no radiation exposure, but may be less accurate than central DXA. QUS does not measure BMD, so before it can be used for clinical decisions, a method for converting QUS results to DXA scale needs to be developed.
Answer: A. Small. Overall, the USPSTF found adequate evidence that the harms associated with osteoporosis medications is small. Serious adverse events associated with bisphosphonates, the most commonly used osteoporosis medications, include upper gastrointestinal and cardiovascular events. The USPSTF found that risk of harms associated with bisphosphonates is also small.
US Preventive Services Task Force, Curry SJ, Krist AH, et al. Screening for osteoporosis to prevent fractures: US preventive services task force recommendation statement. JAMA. 2018;319:2521-2531.