Study: Osteoporosis Screening Guidelines Are Inadequate

Current guidelines for bone-density testing aren’t good enough, according to a new investigation. The study, led by researchers from UCLA, contradicts guidelines from the U.S. Preventive Services Task Force (USPSTF).

The USPSTF, whose findings are consistently reported widely, recommends that all women 65 and older be tested for low bone mineral density. Additionally, the group says that post-menopausal women aged 50 to 64 should get a bone mineral density screening if their 10-year likelihood of suffering several kinds of fracture is 9.3 percent or greater. That probability is based on the Fracture Risk Assessment Tool.

But the latest research, published in The Journal of Clinical Endocrinology & Metabolism, found that the measures recommended by the task force predicted only slightly more than one fourth of the women who later had major fractures.

And, researchers found, two other risk-assessment tools for osteoporosis had a low rate of accuracy as well. The Osteoporosis Self-Assessment Tool (OST) is based on a person’s weight and age, and the Simple Calculated Osteoporosis Risk Estimation Tool (SCORE), uses race, weight, age, history of rheumatoid arthritis, history of non-traumatic fracture and use of estrogen therapy.

“If we want to prevent fractures, we need tools that help us accurately predict who will suffer these osteoporotic injuries so that we can target these at-risk people for preventive measures,” said Dr. Carolyn Crandall, professor of medicine at the David Geffen School of Medicine at UCLA, and the study’s primary investigator. “Our results suggest that our current guidelines for screening in younger post-menopausal women do not accurately identify who will suffer a fracture.”

In their analysis, the researchers looked at statistics from the Women’s Health Initiative. That study collected data about osteoporosis risk factors, as well fractures during 10 years’ time, from 62,492 postmenopausal women ages 50 to 64. Of the women studied, 85 percent were white, 9 percent were black, and 4 percent were Hispanic. The average age was 57.9.

Overall, the UCLA study found, the USPSTF strategy captured only 25.8 percent of the women who suffered fractures within 10 years. As for the risk-assessment tools, SCORE captured 38.6 percent and OST caught 39.8 percent.
The authors acknowledged that there are some weaknesses in their conclusions – for example, the women in the study may be healthier than women in the general population. So it’s possible that the findings may not hold true for all older women.

Nonetheless, the findings indicated the inadequacy of the USPSTF recommendations, the investigators said.

“Neither the USPSTF nor the other two screening strategies performed better than chance alone in discriminating women who did and did not have subsequent fractures,” the researchers write. “These findings highlight the pressing need for further prospective evaluation of alternative strategies with the goal of better targeting resources to at-risk young postmenopausal women. Our findings do not support use of the USPSTF strategy or the other tools we tested to identify younger postmenopausal women who are at higher risk of fracture.”

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