New Expanded Osteoporosis Screening Guidelines
It’s interesting that the USPSTF is publishing new guidelines for screening of osteoporosis just as more questions develop about the long term treatment of osteoporosis with bisphosphonates. In the first USPSTF recommendation update that’s been released after the new protocol for posting anticipated updates for public comment, the task force now gives a Grade B recommendation for osteoporosis screening for all women age 65 or older, as well as for younger women who are estimated to have a risk as high or higher than a 65 year old woman with no additional risk factors.
The statement specifically recommends DEXA screening of the hip and lumbar spine, but does not specifically recommend a particular treatment, but rather leaves that to the physician and patient to decide after weighing the pros and cons of the various options.
No recommendation (Grade I: insufficient evidence) is give to screening for men.
There has been a lot written about the risks of atypical femur fractures and osteonecrosis of the jaw in long term treatment with bisphosphonates. The benefits of these drugs seems to outweigh these risks in general. Still it is not clear how long we should use these drugs, and whether the benefits are lasting after a several year course of treatment, or only last as long as treatment continues. Clearly there is more research needed to answer these questions.
The task force also gives no specific guidelines as to how to assess the risk for women age less than 65. Generally considered risk factors for osteoporosis include smoking, thyroid therapy, corticosteroid treatment, thin body habitus, poor calcium intake, sedentary lifestyle, and prior fractures.
My practice has been to try to screen women in the 50-65 age range if they have multiple risk factors or at 65 if not. I’ll continue this routine, but it’s good to have the new recommendation as it will make Medicare coverage for DEXA a preventative service, I believe with no co-pay or deductible. Comments as to experience with this issue are welcome on this medical blog.