USPSTF recommends osteoporosis screening for senior women to prevent fractures

USPSTF recommends osteoporosis screening for senior women to prevent fractures | Image Credit: © RFBSIP - © RFBSIP - stock.adobe.com.

Women aged 65 years or older should receive osteoporosis screening to prevent osteoporosis fractures, according to the US Preventive Services Task Force (USPSTF).¹

According to the USPSTF, there is a moderate net benefit from osteoporosis screening in this population. This benefit was also reported for postmenopausal women aged under 65 years with increased osteoporosis risk.

“For the current recommendation, the USPSTF has noted that screening can include dual-energy x-ray absorptiometry (DXA) bone mineral density (BMD), with or without fracture risk assessment,” wrote USPSTF authors. “The current recommendation is otherwise generally consistent with the 2018 recommendation.”

The recommendations were designed for adults aged at least 40 years without secondary osteoporosis because of an underlying medical condition. Osteoporosis was based on the World Health Organization definition as hip or lumbar spine bone density of 2.5 standard deviations or lower than the mean BMD in postmenopausal White women.

The risk of fractures is significantly increased among older patients compared to younger patients with the same BMD. For women aged under 65 years, the USPSTF recommended a 2-step approach to determine if screening is needed.

In the first step, clinicians should determine the presence of risk factors for fractures such as parental history of hip fracture, low body weight, cigarette smoking, menopausal status, and excess alcohol consumption. Afterward, a clinical risk assessment tool should be used in patients with at least 1 of these risk factors to determine the need for screening.

DXA at a central site such as total hip or lumbar spine is the most common bone measurement test for osteoporosis screening. Risk assessment tools are also available to incorporate other risk factors for identifying osteoporosis risk.

The efficacy of DXA for measuring bone health was reported at The Menopause Society 2023 Annual Conference.² According to The Menopause Society, 60% to 75% of bone strength is accounted for by bone mass, making DXA effective toward assessing bone fracture risk in postmenopausal women.

For treatment options of osteoporosis, the USPSTF highlighted drug therapies approved by the FDA such as denosumab, romosozumab, bisphosphonates, raloxifene, calcitonin, parathyroid hormone, and estrogen.¹ The USPSTF also warned that some treatment guidelines may be based on rare-specific calculators that are less likely to identify individuals of a marginalized race or ethnicity.

Additional USPSTF recommendations include exercise interventions that reduce the risk of falling in older individuals at increased risk of falls. However, the USPSTF does not recommend supplementation with up to 400 IU vitamin D and up to 1000 mg of calcium among postmenopausal women, citing insufficient evidence.

The USPSTF also highlighted data supporting these updated guidelines. This data was obtained from a review evaluating the benefits and harms of osteoporosis screening in adults aged at least 40 years for the purpose of fracture prevention.

Thirteen unique cohorts measuring BMD alone for predicting major osteoporotic fracture were assessed in the review. The areas under the receiver operating characteristic curve (AUCs) in these cohorts ranged from 0.60 to 0.80. In the 12 cohorts reporting hip fracture risk, AUCs ranged from 0.64 to 0.86.

While fewer studies evaluated the prediction accuracy of BMD in women aged under 65 years, 1 trial with participants aged 45 to 54 years reported an AUC of 0.64 in 3 to 12 years of follow-up for BMD of 0.64.

This data supported the USPSTF’s recommendations of screening for osteoporosis in women aged 65 years and older. “The USPSTF concludes with moderate certainty that screening for osteoporosis to prevent osteoporotic fractures in women 65 years or older has moderate net benefit,” wrote authors.

References

1. Screening for osteoporosis to prevent fractures: US Preventive Services Task Force recommendation statement. JAMA. 2025. doi:10.1001/jama.2024.27154
2. Krewson C. Improvements made in technology measuring bone health. Contemporary OB/GYN. September 29, 2023. Accessed January 17, 2024. https://www.contemporaryobgyn.net/view/improvements-made-in-technology-measuring-bone-health