USPSTF Finalizes 2024 Osteoporosis Screening Recommendations

Carolyn J. Crandall, MD, MS

Credit: UCLA

The US Preventive Services Task Force (USPSTF) has released its finalized recommendation statement on screening for osteoporosis to prevent fractures in adults 40 years or older without known osteoporosis or history of fragility fractures, largely preserving guidelines from its 2018 recommendations.^1,2

Similarly to the 2018 recommendations, the USPSTF has given a B recommendation for screening for osteoporosis to prevent osteoporotic fractures in women 65 years or older and for screening for osteoporosis to prevent osteoporotic fractures in postmenopausal women younger than 65 years who are at increased risk for an osteoporotic fracture as estimated by clinical risk assessment. It has also concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures in men.

Unlike the 2018 statement, which recommended assessing risk of osteoporosis in these women using a formal clinical risk assessment tool, the 2024 recommendations recommend screening those at increased risk for an osteoporotic fracture as estimated by clinical risk assessment. Additionally, the 2024 recommendation defines screening as central (hip or lumbar spine) dual-energy x-ray absorptiometry (DXA) bone mineral density (BMD) testing with or without fracture risk assessment while the 2018 recommendation broadly specified screening as bone measurement testing.^1,2

In a related editorial, Kristine E. Ensrud, MD, MPH, and Carolyn J. Crandall, MD, MS, expand on the difficulties of risk assessment for fracture or osteoporosis. The USPSTF’s recommended clinical risk assessment tools include the Osteoporosis Self-Assessment Tool (OST), the Osteoporosis Risk Assessment Instrument (ORAI), or the Fracture Risk Assessment Tool (FRAX), although the investigators point out that the FRAX calculated without BMD information has been shown to be only slightly more accurate than guessing at chance and the ORAI and OST are more valuable tools.²

The USPSTF acknowledged the need for more research in its statement, stating that “research is needed to develop and validate new primary care–feasible risk assessment tools that accurately predict risk of hip and nonhip major osteoporotic fractures in women and men” and “accurately identify osteoporosis in women and men. This research should include populations broadly representative of the US population and sufficient numbers of postmenopausal women younger than 65 years and men to be able to report on accuracy in these groups.”¹

Ensrud and Crandall also outlined the unknown risk-benefit profile of beginning preventive osteoporosis treatment for younger postmenopausal women aged 50-64 years old without known osteoporosis. They discussed potential drawbacks and risks of bisphosphonate and denosumab treatment, including osteonecrosis of the jaw and atypical femoral fractures.²

“Given scarce resources, time constraints, and competing demands in primary care practice, investigations should con- sider not only the validity and reliability of proposed strategies but also the feasibility and practicality of their application in clinical practice,” Ensrud and Crandall concluded.²

REFERENCES

1. US Preventive Services Task Force. Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. JAMA. Published online January 14, 2025. doi:10.1001/jama.2024.27154

2. US Preventive Services Task Force. Screening for osteoporosis to prevent fractures: US Preventive Services Task Force recommendation statement. JAMA. 2018;319(24):2521-2531. doi:10.1001/jama. 2018.7498

3. Ensrud KE, Crandall CJ. Fracture Risk Assessment as a Component of Osteoporosis Screening— Easier Said Than Done. JAMA. Published online January 14, 2025. doi:10.1001/jama.2024.27416