USPSTF Issues Final Recommendations on Osteoporosis Screening to Prevent Fractures

In a final recommendation statement published in JAMA, the US Preventive Services Task Force (USPSTF) said that all women aged 65 years and older should be screened for osteoporosis to prevent fractures.¹

The task force also recommends screening postmenopausal women aged younger than 65 years who are at an increased risk for an osteoporotic fracture. Both are B-grade recommendation statements and apply to adults who do not have a history of fragility fractures or health conditions that could weaken bones.¹

“Too often, the first sign of osteoporosis is a broken bone, which can lead to serious health issues,” USPSTF member Esa Davis, MD, MPH, said in a January 14, 2025, press release.² “The good news is that for women 65 years or older, as well as younger women at increased risk, screening can detect osteoporosis early—before fractures happen—helping women maintain their health, independence, and quality of life.”

For postmenopausal women under 65, the USPSTF suggests an initial assessment for risk factors, followed by the use of clinical risk assessment tools to determine the necessity of screening. Women identified as having osteoporosis should receive further evaluation and evidence-based care management to mitigate the risk of fractures.¹

Conversely, the USPSTF found insufficient evidence to recommend for or against osteoporosis screening in men (I statement), concluding that the balance of benefits and harms remains undetermined for this population. “Clinicians should use their clinical judgment regarding whether to screen for osteoporosis" in men,” the task force stated in JAMA.¹

Data underpinning the recommendation statement included 145 unique studies assessed in a systematic evidence review, which showed that osteoporosis screening was associated with reduced hip fractures (pooled relative risk [RR] 0.83, 95% CI 0.73-0.93) and major osteoporotic fractures (pooled RR 0.94, 95% CI 0.88-0.99) compared with usual care. Absolute risk differences were 5 fewer hip fractures and 6 fewer major osteoporotic fractures per 1000 participants screened, according to the review.¹

The guidance is broadly consistent with the USPSTF’s 2018 recommendation on the topic, but unlike the previous recommendation, the task force does not specifically reference using bone mineral density (BMD) alone as a screening tool in women aged 65 years and older. Now, BMD can be used with or without risk assessment in this population, the USPSTF said.¹

According to the USPSTF, there are several assessment tools that can be used to estimate a person’s future risk for fracture, such as the Fracture Risk Calculator (FRC), Garvan Fracture Risk Calculator, and the Fracture Risk Assessment Tool (FRAX). There are also the Osteoporosis Risk Assessment Instrument and Osteoporosis Self-assessment Tool, which can be used by clinicians to identify osteoporosis.¹

However, many of these risk assessment tools have limitations in predicting fracture risk for Asian, Hispanic and Black populations, which clinicians should be aware of, the USPSTF noted.¹

In a related editorial, Kristine E. Ensrud, MD, MPH, a professor at the University of Minnesota School of Public Health, and Carolyn J. Crandall, MD, a professor in the department of medicine at the University of California, Los Angeles, explained that screening for osteoporosis in younger postmenopausal women may be a challenge because of several factors such as³:

• time constraints;
• a lack of resources;
• an absence of tools that accurately estimate long-term fracture risk in this population; and
• gaps in evidence on the harms and benefits of starting osteoporosis drug treatment for fracture prevention in postmenopausal women aged 50 to 64 years and continuing the treatment uninterrupted or with temporary pauses throughout the rest of their lifetime.

As a result, future investigations into the benefits and harms of osteoporosis screening “should consider not only the validity and reliability of proposed strategies but also the feasibility and practicality of their application in clinical practice,” Ensrud and Crandall wrote.³

References:

1. U.S. Preventive Services Task Force, Nicholson W, Silverstein M, et al. Screening for osteoporosis to prevent fractures: US Preventive Services Task Force recommendation statement JAMA. Published online January 14, 2025. doi:10.1001/jama.2024.27154.

2. U.S. Preventive Services Task Force. U.S. Preventive Services Task Force issues final recommendation on screening for osteoporosis to prevent fractures. News release. January 14, 2025. Accessed January 15, 2025. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/osteoporosis-screening-final-rec-bulletin.pdf

3. Ensrud KE, Crandall CJ. Fracture risk assessment as a component of osteoporosis screening—easier said than done. JAMA. Published online January 14, 2025. doi:10.1001/jama.2024.27416