22 Oct Recommended Osteoporosis Screening May Not Effectively Screen Younger Patients
Medical Research: What are the main findings of the study?
Dr. Crandall: Clinical guidelines recommend that women aged ≥ 65 years should be screened for osteoporosis. However, for younger postmenopausal women aged between 50 and 64 years, the United States Preventive Services Task Force (USPSTF) recommends osteoporosis screening for women who have a 10-year predicted risk of osteoporosis fracture that is ≥9.3%. We tested the ability the USPSTF strategy, and two other strategies (called OST and SCORE), to distinguish between women who did and did not experience a fracture in the subsequent 10 years. We found that the USPSTF strategy did not identify the majority of who experienced osteoporotic fracture in the subsequent 10 years. Especially in women aged 50-54 years, the USPSTF strategy identified fewer than 5% of women who experienced fracture over 10-year follow-up.
Medical Research: What was most surprising about the results?
Dr. Crandall: The strategy that is recommended by current USPSTF clinical guidelines does not perform well among these younger postmenopausal women in terms of distinguishing which women will, and will not, experience a fracture in the subsequent 10 years. In fact, in these women aged between 50 and 64 years, the ability to discriminate between women with and without fractures was not substantially better than chance alone for all 3 strategies that we examined.
Medical Research: What should clinicians and patients take away from your report?
Dr. Crandall: To optimally predict fractures in younger postmenopausal women, we probably have to consider risk factors that are not included in the available risk assessment tools.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Crandall: Clearly new approaches will have to be developed to fill this critical knowledge gap, in order to have at-risk women and their clinicians feel empowered to take measures prior to the occurrence of a fracture.
JCEM: Carolyn J. Crandall, Joseph C. Larson, Nelson B. Watts, Margaret L. Gourlay, Meghan G. Donaldson, Andrea LaCroix, Jane A. Cauley, Jean Wactawski-Wende, Margery L. Gass, John A. Robbins, and Kristine E. Ensrud