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Osteoporosis Screening in Younger Postmenopausal Women

Educational Objective
To understand the importance of screening younger postmenopausal women for osteoporosis
1 Credit CME

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).

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Article Information

Corresponding Author: Carolyn J. Crandall, MD, MS, David Geffen School of Medicine at University of California, Los Angeles, Division of General Internal Medicine and Health Services Research, 1100 Glendon Ave, Ste 850 - Room 858, Los Angeles, CA 90024 (ccrandall@mednet.ucla.edu).

Published Online: January 9, 2020. doi:10.1001/jama.2019.18343

Conflict of Interest Disclosures: Dr Ensrud reported receiving grants from Merck & Co outside the submitted work. No other disclosures were reported.

References
1.
US Preventive Services Task Force.  Screening for osteoporosis to prevent fractures: US Preventive Services Task Force Recommendation Statement.  JAMA. 2018;319(24):2521-2531. doi:10.1001/jama.2018.7498PubMedGoogle ScholarCrossref
2.
Doherty  DA, Sanders  KM, Kotowicz  MA, Prince  RL.  Lifetime and five-year age-specific risks of first and subsequent osteoporotic fractures in postmenopausal women.  Osteoporos Int. 2001;12(1):16-23. doi:10.1007/s001980170152PubMedGoogle ScholarCrossref
3.
Crandall  CJ, Larson  J, Gourlay  ML,  et al.  Osteoporosis screening in postmenopausal women 50 to 64 years old: comparison of US Preventive Services Task Force strategy and two traditional strategies in the Women’s Health Initiative.  J Bone Miner Res. 2014;29(7):1661-1666. doi:10.1002/jbmr.2174PubMedGoogle ScholarCrossref
4.
Bansal  S, Pecina  JL, Merry  SP,  et al.  US Preventive Services Task Force FRAX threshold has a low sensitivity to detect osteoporosis in women ages 50-64 years.  Osteoporos Int. 2015;26(4):1429-1433. doi:10.1007/s00198-015-3026-0PubMedGoogle ScholarCrossref
5.
Crandall  CJ, Larson  JC, Watts  NB,  et al.  Comparison of fracture risk prediction by the US Preventive Services Task Force strategy and two alternative strategies in women 50-64 years old in the Women’s Health Initiative.  J Clin Endocrinol Metab. 2014;99(12):4514-4522. doi:10.1210/jc.2014-2332PubMedGoogle ScholarCrossref
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