The U.S. Preventive Services Task Force has issued draft recommendations on osteoporosis screening, reaffirming support for screening older women to prevent fractures, while calling for additional research to determine potential benefits for men.

The draft update maintains a "B" rating for osteoporosis screening in women aged 65 and older, as well as postmenopausal women under 65 at increased risk for osteoporotic fractures. The new language removes the specific requirement for "bone measurement testing," providing more flexibility for screening methods. The recommendations do not apply to patients with secondary osteoporosis due to underlying conditions such as cancer or chronic medication use.

"Screening for osteoporosis is an effective way to prevent fractures in women 65 and older and in younger women who have gone through menopause and are at increased risk of osteoporosis or fractures," said Esa Davis, M.D. " Too often women don't know they have osteoporosis until after a fracture occurs, and these fractures can lead to decreased quality of life, disability, and even death."

The USPSTF draft continues to issue an "I" grade for screening men, indicating insufficient evidence to assess the balance of benefits and harms. The task force called for more studies on the benefits and harms of screening men for osteoporosis.

"Osteoporosis affects both men and women, and fractures in men result in more disability and death, which is why the Task Force is calling for more research to determine whether it is beneficial to screen men for osteoporosis," said USPSTF vice chair John Wong, M.D.

The USPSTF highlighted several risk factors for fragility fractures, including increasing age, low body mass index, excessive alcohol intake, smoking, chronic corticosteroid use, history of prior fractures, falls, cerebrovascular accidents, and diabetes. They also noted limitations with some clinical risk assessment tools, which may under identify high-risk patients among Black, Hispanic, and Asian populations, potentially leading to disparities in treatment compared to White patients with similar risk profiles.

"It is important that clinicians be aware of these limitations, and they may also want to consider additional risk factors, to help inform discussions with their patients and determine whether screening or treatment for osteoporosis is needed," the USPSTF noted. The draft recommendation statement and evidence review are available for public comment on the USPSTF website until July 8, 2024.