New U.S. Guideline Would Expand Bone Density Testing

The draft guidelines by the U.S. Preventive Services Task Force (USPSTF), sponsored by the Agency for Healthcare Research and Quality, call for all women to be screened for osteoporosis starting at the age of 65. Women who are deemed to have higher risks could start earlier.

The group's last guidelines, in 2002, had the same recommendations for all women aged 65 and older, but said that high-risk women should not begin screening until the age of 60. The new draft is based on a review of evidence published in the Annals of Internal Medicine since the previous guidelines were issued.

It's unclear how many additional women will now fit the screening criteria, task force chair Ned Calonge, MD, MPH, told Reuters Health. "The good news," he said, is that it's the minority of women between 50 and 64 who will be at high risk.

"What physicians should do is not pull out the DXA machine," Calonge said, referring to the device usually used for bone mineral density tests, "but calculate clinical risk factors" in women under the age of 65.

Ultrasound, which is cheaper and does not involve radiation, has also been shown to effectively predict fractures, and is also commonly used. However, most diagnostic criteria refer to DXA measurements.

In the new draft, the USPSTF does not recommend testing men for the disease, saying there is not enough evidence to show a benefit. The National Institutes of Health estimates that about 2 million men in the U.S. have osteoporosis, accounting for about one fifth of cases overall.

For women, the draft guidelines are similar to those of the American Congress of Obstetricians and Gynecologists, and also to those of the National Osteoporosis Foundation.

The release of these draft guidelines mark a change in how the USPSTF will put forth its recommendations, Calonge told Reuters Health. In the past, they simply released final versions of their recommendations, but they have been quietly working on ways to release drafts for public comment, before the guidelines were final.

For one month, the draft will be available for comment on the group's website. Based on the feedback, the group may change its recommendations.

"We've decided that since the miscommunication and the reaction to the breast cancer screening guidelines, that we wanted to accelerate the process," Calonge said, referring to mammography recommendations released last November that were met with controversy.

The 2002 osteoporosis screening recommendations remain in force until the new ones are finalized, Calonge said. "We're not recommending clinicians use this recommendation until final release."

Source: Reuters Health