Bone Density

Screening for Osteoporosis to Prevent Fractures

Alex Haga — Thu, 23 Jan 2025 19:19:02 +0000

Date Added:

January 23, 2025

Journal/Publication:

JAMA

Publication Date:

January 14, 2025

URL:

Screening for Osteoporosis to Prevent Fractures

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jama.2024.27771

Keywords

osteoporosis

PMID (1):

39808444

MeSH

Bone Density

osteoporosis

hip fractures

Information for patients about osteoporosis screening. James W. Mold, MD, MPH

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This JAMA Patient Page describes osteoporosis and the US Preventive Services Task Force recommendations for screening for osteoporosis.

Author/s:

Jill Jin

Recommendations on screening for primary prevention of fragility fractures

Aubrey Delammermore — Wed, 10 May 2023 05:00:00 +0000

Date Added:

May 10, 2023

Journal/Publication:

Canadian Medical Association Journal

Publisher:

CMA Impact Inc

Publication Date:

May 8, 2023

Issue:

Volume:

195

Pages:

E639-E649

URL:

Recommendations on screening for primary prevention of fragility fractures

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.221219

Keywords

PMID (1):

37156553

MeSH

Absorptiometry, Photon

Osteoporotic Fractures* / prevention & control

Bone Density

primary prevention

quality of life

A rational approach to screening to reduce hip fractures in older women from the Canadians. James W. Mold, MD, MPH

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Background: Fragility fractures are a major health concern for older adults and can result in disability, admission to hospital and long-term care, and reduced quality of life. This Canadian Task Force on Preventive Health Care (task force) guideline provides evidence-based recommendations on screening to prevent fragility fractures in community-dwelling individuals aged 40 years and older who are not currently on preventive pharmacotherapy.

Methods: We commissioned systematic reviews on benefits and harms of screening, predictive accuracy of risk assessment tools, patient acceptability and benefits of treatment. We analyzed treatment harms via a rapid overview of reviews. We further examined patient values and preferences via focus groups and engaged stakeholders at key points throughout the project. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to determine the certainty of evidence for each outcome and strength of recommendations, and adhered to Appraisal of Guidelines for Research and Evaluation (AGREE), Guidelines International Network and Guidance for Reporting Involvement of Patients and the Public (GRIPP-2) reporting guidance.

Recommendations: We recommend "risk assessment-first" screening for prevention of fragility fractures in females aged 65 years and older, with initial application of the Canadian clinical Fracture Risk Assessment Tool (FRAX) without bone mineral density (BMD). The FRAX result should be used to facilitate shared decision-making about the possible benefits and harms of preventive pharmacotherapy. After this discussion, if preventive pharmacotherapy is being considered, clinicians should request BMD measurement using dual-energy x-ray absorptiometry (DXA) of the femoral neck, and re-estimate fracture risk by adding the BMD T-score into FRAX (conditional recommendation, low-certainty evidence). We recommend against screening females aged 40-64 years and males aged 40 years and older (strong recommendation, very low-certainty evidence). These recommendations apply to community-dwelling individuals who are not currently on pharmacotherapy to prevent fragility fractures.

Interpretation: Risk assessment-first screening for females aged 65 years and older facilitates shared decision-making and allows patients to consider preventive pharmacotherapy within their individual risk context (before BMD). Recommendations against screening males and younger females emphasize the importance of good clinical practice, where clinicians are alert to changes in health that may indicate the patient has experienced or is at higher risk of fragility fracture.

Author/s:

Thériault, G., Limburg, H., Klarenbach, S., Reynolds, D. L., Riva, J. J., Thombs, B. D., Tessier, L. A., Grad, R., Wilson, B. J., Canadian Task Force on Preventive Health Care

Osteoporosis Screening in Younger Postmenopausal Women

Brian Desmarais — Sat, 11 Jan 2020 20:19:49 +0000

Date Added:

January 11, 2020

Journal/Publication:

Journal of the American Medical Association

Publication Date:

January 9, 2020

URL:

Osteoporosis Screening in Younger Postmenopausal Women

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

doi:10.1001/jama.2019.18343

Keywords

MeSH

osteoporotic fractures

This is a nice review of when to consider screening for osteoporosis in postmenopausal women younger than 65. James W. Mold, MD, MPH

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Osteoporotic fractures, especially hip fractures, are associated with mobility limitations, chronic disability, loss of independence, and reduced quality of life.

Several randomized trials have demonstrated the benefit of drug treatment in reducing clinical fractures among postmenopausal women with existing vertebral fractures or bone mineral density (BMD) T-scores of −2.5 or lower and among adults aged 50 years and older with recent hip fracture.

Thus, osteoporosis in the clinical setting should be diagnosed in patients with a history of hip or clinical vertebral fracture not due to excessive trauma, those with existing radiographic vertebral fractures, and those with a BMD T-score of −2.5 or lower at the hip (femoral neck or total hip) or lumbar spine. In the absence of a history of hip or vertebral fracture, osteoporosis screening is aimed at identifying individuals with a BMD T-score of −2.5 or lower because those individuals may be candidates for osteoporosis pharmacotherapy. The BMD T-score quantifies the difference (expressed in standard deviations) between a patient’s BMD and the average BMD of young adult white women (reference group).

Author/s:

Crandall, C.J., Ensrud, Kristine E.

Bisphosphonates for Postmenopausal Osteoporosis

John Bayhi — Sat, 19 Oct 2019 14:38:56 +0000

Date Added:

October 19, 2019

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

October 17, 2019

URL:

Bisphosphonates for Postmenopausal Osteoporosis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2019.15781

Keywords

post-menopausal osteoporosis

bisphosphonates

antiresorptive agents

PMID (1):

31621799

MeSH

Bone Density Conservation Agents

Raloxifene Hydrochloride

Risedronate Sodium

Alendronate

Osteoporosis, Postmenopausal

Selective Estrogen Receptor Modulators

Gatroesophageal Reflux

Estrogens

vitamin D deficiency

Peptic Ulcer

risk reduction behavior

A short, sweet review of how, when, and for how long to treat postmenopausal osteoporosis. James W. Mold, MD, MPH

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Bisphosphonates are the first-line pharmacologic treatment for postmenopausal osteoporosis and the most commonly prescribed medication for this condition.1 Bisphosphonates, classified as antiresorptive agents, have a very high affinity for bone mineral and bind to hydroxyapatite crystals on bony surfaces, where they inhibit osteoclast-mediated bone resorption.

Author/s:

Ensrud, KE, Crandall, CJ