title: Use of FRAX as a determinant for risk-based osteoporosis screening may decrease unnecessary testing while improving the odds of identifying treatment candidates.
abstract: OBJECTIVE
  We have assessed the hypothetical impact of guideline-concordant osteoporosis screening on baseline behaviors utilizing two different guidelines and determined the relative ability of each to identify osteoporosis treatment candidates.
  
  
  METHODS
  We conducted secondary analyses from the Fracture Risk Perception Study, which enrolled patients aged 50 to 75 years to complete questionnaires about their bone health. We determined our baseline screening rates and detection of treatment candidates and then assessed the hypothetical impact of adherence to U.S. Preventive Services Task Force (USPSTF) and National Osteoporosis Foundation (NOF) criteria, particularly for women aged 50 to 64.
  
  
  RESULTS
  Of 144 women aged 50 to 64 years screened, 14 (9.7%) were treatment candidates. Screening based on identification of one or more risks (NOF) would lead to testing of 102 of the 144 patients (71%) to identify 12 of 14 treatment candidates (86%). Applying USPSTF criteria (9.3% FRAX threshold) would test 45 of the same 144 women (31%) to identify 11 of 14 treatment candidates (79%). NOF risk-based criteria would result in a moderate absolute screening rate reduction (16%, p = .0011; 95% CI, 7%-25%), but only marginal improvement in identifying treatment candidates (odds ratio, 2.67; 95% CI, 0.57-12.47). Applying the more selective USPSTF criteria greatly reduced unnecessary testing (56% absolute screening rate reduction; p < .0001; 95% CI, 47%-64%) while further improving the odds of identifying treatment candidates (odds ratio, 10.35; 95% CI, 2.72-39.35).
  
  
  CONCLUSIONS
  When contemplating screening younger patients, systematic calculation of FRAX and ordering only when the 9.3% fracture risk threshold is reached may decrease unnecessary screening for many women while still identifying appropriate osteoporosis treatment candidates.
authors.affiliation: Department of Family Medicine, Mayo Clinic, Scottsdale, Arizona. Electronic address: edwards.frederick@mayo.edu.
authors.forename: Frederick D
authors.initials: FD
authors.lastname: Edwards
authors.affiliation: Department of Family Medicine, Mayo Clinic, Scottsdale, Arizona.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Grover
authors.affiliation: Division of Endocrinology, Mayo Clinic, Scottsdale, Arizona; Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Scottsdale, Arizona.
authors.forename: Curtiss B
authors.initials: CB
authors.lastname: Cook
authors.affiliation: Division of Biostatistics, Mayo Clinic, Scottsdale, Arizona.
authors.forename: Yu-Hui H
authors.initials: YH
authors.lastname: Chang
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods*; D000368:Aged; D015519:Bone Density; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008403:Mass Screening / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D018570:Risk Assessment / Q000379:methods* / Q000592:standards; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014944:World Health Organization