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In an update of its 2011 recommendations, the US Task Force on Preventive Services recommends bone screening to prevent osteoporotic fractures in women aged 65 or older and in postmenopausal women at high risk of osteoporosis. under 65 years old.
However, the USPSTF does not recommend screening for osteoporosis in men, citing insufficient current evidence to assess the balance of benefits and harms. According to the statement: "It can not be assumed that the bones of men and women are biologically the same, especially because bone density is affected by the different levels and effects of testosterone and estrogen in men and women … Men tend to have more advanced age fractures than women, when the risk of co-morbidity and overall mortality are higher, so the net balance of benefits and harms of screening and treatment of osteoporosis in men is not clear. "
As previously reported by Healio.com, a draft version of these recommendations has been released for public comment from November to December 2017.
The USPSTF cited "compelling evidence" on the accuracy of bone measurement tests – including commonly used DXA, peripheral DXA and quantitative ultrasound – to detect osteoporosis and prevent related fractures in patients with osteoporosis. women and men. In its review, the USPSTF found "adequate evidence" on the accuracy of clinical risk assessment tools to identify osteoporosis and related fractures. The recommended clinical risk assessment tools include the simple osteoporosis risk assessment calculator (SCORE, Merck), the osteoporotic risk assessment instrument, the most commonly used risk assessment tool. OSIRIS, osteoporosis self-assessment tool and fracture risk assessment tool. FRAX). The 2011 recommendations endorsed FRAX in the younger group, but expanded the 2018 recommendation to a number of formal tools for clinical risk assessment. To determine which postmenopausal women under the age of 65 must undergo a bone measurement test, clinicians must first consider osteoporosis risk factors such as hip fractures, smoking, excessive consumption of bone, and the risk of osteoporosis. Alcohol and low body weight.
The USPSTF has also found "compelling evidence" that available drug therapies reduce fracture rates in postmenopausal women, with a "low likelihood of serious harm". The working group did not recommend any drug treatments. based.
New evidence on the benefits of screening, the disadvantages
Also published in JAMA is an updated report of evidence and a systematic review for the USPSTF on the pros and cons of screening and treatment to prevent osteoporotic fractures in adults residing in the United States. Meera Viswanathan, PhD, of RTI International-University of North Carolina at Chapel Hill's Evidence-Based Practice Center, and colleagues analyzed data from PubMed, the Cochrane Library, EMBASE, and trial registries from November 2009 to October 2016 and monitored literature until March.
Their research resulted in 168 equitable or good-quality studies that assessed screening, bone-testing or clinical risk assessment and pharmacological treatment of osteoporosis in elderly adults aged 15 to 18 years. under 40 years old. A trial of 12,483 participants comparing screening vs. no screening gave fewer hip fractures (HR = 0.72, 95% CI, 0.59-0.89), but no other disadvantages or significant benefits of screening. The accuracy of specific bone measurement tests and clinical risk assessments showed benefits, but varied across studies.
Evidence on osteoporosis treatment options was inconsistent. In women, treatment with bisphosphonates, parathyroid hormone, raloxifene and denosumab (Prolia, Amgen) has been associated with reduced risk of vertebral fractures in nine studies. The risk of non-vertebral fractures was lower with bisphosphonates in nine studies and denosumab in one study. Denosumab was also associated with a reduced risk of hip fracture. Evidence was inconsistent among men, with a study showing a lower risk of radiographic vertebral fractures and no studies showing reductions in clinical or hip fractures. Aside from deep vein thrombosis, bisphosphonates are not systematically linked to other reported damage, according to the report.
"In women, screening to prevent osteoporotic fractures can reduce hip fractures, and treatment reduces the risk of vertebral and non-vertebral fractures, there was no consistent evidence of harmful treatments." 39 accuracy of bone measurement tests or clinical risk assessments for the identification of osteoporosis or fracture prediction ranged from very poor to good, "wrote Mr. Viswanathan and his colleagues.
& # 39;Fracture prevention is the ultimate goal
In a related editorial, Jane A. Cauley, DrPH, Distinguished Professor in the Department of Epidemiology and Associate Dean for Research at the Graduate School of Public Health of the University of Pittsburgh, noted that the updated recommendation statement and evidence report are "timely".
According to current projections, 12.3 million US adults over 50 years old are expected to suffer from osteoporosis by 2020.
"Fracture prevention is the ultimate goal, and [bone mineral density] Screening is an effective, inexpensive and non-invasive way to identify men and women at high risk of fracture. However, major deficiencies remain in the detection of BMD, even in women 65 years and older. The evaluation of clinical risk factors is also important because people with low BMD and an increasing number of risk factors have the highest incidence of hip fracture. Screening should be followed by effective treatment and prevention of falls among high-risk individuals.
"Future research should identify ways to improve BMD screening rates and improve the identification of young women (50-64 years old) and older men who would benefit from screening." the BMD, "wrote Cauley.
The references:
Judge Cauley JAMA. 2018; doi:
Task Force on Preventive Services in the United States. JAMA. 2018; doi: 10.1001 / jama.2018.7498.
Viswanathan M, et al. JAMA. 2018; doi: 10.1001 / jama.2018.6537.
Disclosures Cauley, Viswanathan and other authors do not report any relevant financial information. All members of the USPSTF receive travel reimbursement and fees to attend USPSTF meetings; no other disclosure has been reported.
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