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This publication is provided for historical reference only and the information may be out of date.

Cover of Screening for Postmenopausal Osteoporosis

Screening for Postmenopausal Osteoporosis

Systematic Evidence Reviews, No. 17

, MD, MPH and , MD, MS.

Oregon Health Sciences University Evidence-based Practice Center, Portland, Oregon

Structured Abstract

Context:

The incidence of osteoporotic fractures increases with age and is associated with a significant health burden.

Objective:

To examine evidence on the benefits and harms of screening asymptomatic postmenopausal women for osteoporosis.

Data Sources:

MEDLINE (1966 to May 2001), HealthSTAR (1975 to May 2001), and Cochrane databases, reference lists of systematic reviews, and experts.

Study Selection:

We included English-language abstracts with original data about postmenopausal women and osteoporosis that addressed the effectiveness of risk factor assessment, bone measurement tests, or treatment. Two reviewers read each abstract to determine its eligibility.

Data Extraction:

We extracted selected information about the patient population, interventions, clinical endpoints, and study design, and applied a set of criteria to evaluate study quality.

Data Synthesis:

Although many studies have been published about osteoporosis in postmenopausal women, there have been no trials of screening and, therefore, no direct evidence that screening improves outcomes. Instruments developed to assess clinical risk factors for low bone density or fractures generally have moderate-to-high sensitivity and low specificity, many have not been validated, and none have been widely tested in a practice setting. Among different bone density tests measured at various sites, bone density measured at the femoral neck by dual-energy x-ray absorptiometry is the best predictor of hip fracture and is comparable to forearm measurements for predicting fractures at other sites. Women with low bone density have a 40% to 50% reduction in fracture risk when treated with raloxifene (vertebral fractures) or bisphosphonates (both vertebral and nonvertebral fractures). Trials of estrogen are inconclusive because of methodologic limitations.

Conclusions:

Although there is no direct evidence that screening prevents fractures, there is evidence that the prevalences of osteoporosis and fractures increase with age, that the short-term risk of fracture can be estimated by bone measurement tests and risk factor assessment, and that treatment may reduce fracture risk among women with low bone density.

Contents

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-97-0018, Task Order No. 2, Technical Support of the U.S. Preventive Services Task Force. Prepared by: Oregon Health Sciences University Evidence-based Practice Center, Portland, Oregon.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

AHRQ is the lead Federal agency charged with supporting research designed to improve the quality of health care, reduce its cost, address patient safety and medical errors, and broaden access to essential services. AHRQ sponsors and conducts research that provides evidence-based information on health care outcomes; quality; and cost, use, and access. The information helps health care decisionmakers—patients and clinicians, health system leaders, and policymakers—make more informed decisions and improve the quality of health care services.

The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services of a particular drug, device, test, treatment, or other clinical service.

1

2101 East Jefferson Street, Rockville, MD 20852. www‚Äč.ahrq.gov

Bookshelf ID: NBK42754PMID: 20722112

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