Screening for Postmenopausal Osteoporosis: A Review of the Evidence for the U.S. Preventive Services Task Force

Established in 1927 by the American College of Physicians

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Screening for Postmenopausal Osteoporosis: A Review of the Evidence for the U.S. Preventive Services Task Force

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Table 1. Risk Factors for Fractures in Women 50–65 Years of Age

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Table 2. Studies of Risk Factor Assessment

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Table 3. Prospective Studies of Dual-Energy X-Ray Absorptiometry and Ultrasonography That Reported Hip Fractures

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Table 4. Randomized, Controlled Trials of Alendronate with Fracture Outcomes

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Table 5. Screening for Osteoporosis in 10 000 Postmenopausal Women: Hip and Vertebral Fracture Outcomes by 5-Year Age Intervals

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Figure. Number needed to screen to prevent one hip fracture in 5 years. The dotted line indicates women with at least one risk factor; the solid line indicates women without risk factors.

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Appendix Table 1. Summary of Evidence Quality

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Appendix Table 2. Formulas for Calculations in Outcomes Table

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Appendix Table 3. Criteria for Grading the Internal Validity of Individual Studies

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Appendix Figure. Analytic framework. The analytic framework is a schematic outline used to define the population, preventive service, diagnostic or therapeutic interventions, and intermediate and health outcomes considered in the review. The arrows represent key questions that the evidence must answer, and demonstrate the chain of logic that evidence must support, to link the preventive service to improved health outcomes. KQ = key question. KQ 1: Does screening using risk factor assessment or bone density testing reduce fractures? KQ 2: Does risk factor assessment accurately identify women who may benefit from bone density testing? KQ 3: Do bone density measurements accurately identify women who may benefit from treatment? KQ 4: What are the harms of screening? KQ 5: Does treatment reduce the risk of fractures in women identified by screening? KQ 6: What are the harms of treatment?