Osteoporosis Screening Strategies Don't Identify Younger Women at Risk

Current screening for women between ages 50 and 64 for osteoporosis needs improvement, according to a recent comparison of treatment and screening strategies from different organizations in the United States and Canada.

The authors said they did the study because the best strategy for osteoporosis screening and treatment in this population of postmenopausal women is unclear.

They compared the United States Preventive Services Task Force (USPSTF) and Osteoporosis Canada osteoporosis screening strategies as well as the National Osteoporosis Foundation (NOF) and Canadian treatment strategies.

The study used data from the prospective Women's Health Initiative Observational Study and Clinical Trials of women aged 50 to 79 years at baseline (n = 117,707 followed for self‐reported fractures; n = 8134 in bone mineral density [BMD] subset). The researchers examined the yield of the screening and treatment strategies in identifying women who experienced major osteoporotic fractures (MOF) during 10‐year follow‐up.

Among women aged 50 to 64 years, 23.1% of women were identified for BMD testing under the USPSTF strategy and 52.3% under the Canadian strategy.

For women ≥65 years, 100% were identified for testing under the USPSTF and Canadian strategies, 35% to 74% were identified for treatment under NOF, and 16% to 37% were identified for treatment under the Canadian assessment tool called CAROC (launched in 2005 by Osteoporosis Canada and the Canadian Association of Radiologists).

Among women who experienced MOF during follow‐up, the USPSTF strategy identified 6.7% of women 50 to 54 years‐old and 49.5% of women 60 to 64 years‐old for BMD testing (versus 54.4% and 60.6% for the Canadian strategy, respectively).

However, specificity of the USPSTF strategy was higher than that of the Canadian strategy among women 50 to 64 years‐old.

Among women who experienced MOF during follow‐up, sensitivity for identifying women as treatment candidates was lowest for both strategies in women aged 50 to 64 (NOF 10% to 38%; CAROC 1% to15%) and maximal in 75‐ to 79‐year‐old women (NOF 82.8%; 51.6% CAROC); specificity declined with advancing age and was lower with the NOF than the CAROC strategy.

Among women aged 50‐64 years, the screening and treatment strategies examined had low sensitivity for identifying those who subsequently experience MOF; sensitivity was higher among women ≥65 years than among younger women.