Screening for osteoporosis: an update for the U.S. Preventive Services Task Force.
BACKGROUND
This review updates evidence since the 2002 U.S. Preventive Services Task Force recommendation on osteoporosis screening.


OBJECTIVE
To determine the effectiveness and harms of osteoporosis screening in reducing fractures for men and postmenopausal women without known previous fractures; the performance of risk-assessment instruments and bone measurement tests in identifying persons with osteoporosis; optimal screening intervals; and the efficacy and harms of medications to reduce primary fractures.


METHODS
Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the fourth quarter of 2009), MEDLINE (January 2001 to December 2009), reference lists, and Web of Science.


METHODS
Randomized, controlled trials of screening or medications with fracture outcomes published in English; performance studies of validated risk-assessment instruments; and systematic reviews and population-based studies of bone measurement tests or medication harms.


METHODS
Data on patient populations, study design, analysis, follow-up, and results were abstracted, and study quality was rated by using established criteria.


RESULTS
Risk-assessment instruments are modest predictors of low bone density (area under the curve, 0.13 to 0.87; 14 instruments) and fractures (area under the curve, 0.48 to 0.89; 11 instruments); simple and complex instruments perform similarly. Dual-energy x-ray absorptiometry predicts fractures similarly for men and women; calcaneal quantitative ultrasonography also predicts fractures, but correlation with dual-energy x-ray absorptiometry is low. For postmenopausal women, bisphosphonates, parathyroid hormone, raloxifene, and estrogen reduce primary vertebral fractures. Trials are lacking for men. Bisphosphonates are not consistently associated with serious adverse events; raloxifene and estrogen increase thromboembolic events; and estrogen causes additional adverse events.


CONCLUSIONS
Trials of screening with fracture outcomes, screening intervals, and medications to reduce primary fractures, particularly those enrolling men, are lacking.


CONCLUSIONS
Although methods to identify risk for osteoporotic fractures are available and medications to reduce fractures are effective, no trials directly evaluate screening effectiveness, harms, and intervals.


BACKGROUND
Agency for Healthcare Research and Quality.
Nelson
Heidi D
HD
Oregon Evidence-based Practice Center, Oregon Health & Science University, Portland, OR 97239-3098, USA. nelsonh@ohsu.edu
Haney
Elizabeth M
EM
Dana
Tracy
T
Bougatsos
Christina
C
Chou
Roger
R
D019317:Evidence-Based Medicine; D005260:Female; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008403:Mass Screening; D010024:Osteoporosis / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D011322:Primary Prevention; D018570:Risk Assessment; D012307:Risk Factors