Screening for osteoporosis.
OBJECTIVE
To review evidence that screening for osteoporosis by measuring bone mass in postmenopausal women would reduce fracture incidence.


METHODS
An English-language literature search using MEDLINE (1966 to 1989), bibliographic reviews of book chapters and review articles, technology assessments of bone mass measurement, and other publications.


METHODS
We summarize prospective studies of fracture risk prediction done with widely used bone mass measurement techniques, and we document noncontroversial or peripheral points with recent papers and reviews.


METHODS
Without osteoporosis screening trials, no quantitative analysis is possible. Instead, we assess the ability of screening tests to measure bone mass and define fracture risk categories, the ability of risk categories to determine treatment, and the ability of treatment to reduce fracture incidence.


RESULTS
Bone mass measurement meets many of the criteria for a screening test, and indirect evidence suggests that a screening program might reduce osteoporosis-related fracture incidence. No trial has shown this directly; however, and questions remain about overall benefits and costs of mass screening.


CONCLUSIONS
Although there are clinical indications for bone mass measurement, unselective screening for osteoporosis cannot be recommended until a specific program is formulated and justified.
Melton
L J
LJ
Mayo Clinic, Rochester, Minnesota.
Eddy
D M
DM
Johnston
C C
CC
D015502:Absorptiometry, Photon / Q000379:methods; D015519:Bone Density; D015914:Estrogen Replacement Therapy; D005260:Female; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008403:Mass Screening; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control*; D011237:Predictive Value of Tests; D012306:Risk; D014057:Tomography, X-Ray Computed; D014965:X-Rays