SOURCE: Altkorn D, Cifu AS. Screening for osteoporosis. JAMA 2015;313:1467-1468.

Despite widespread public awareness campaigns, osteoporosis continues to exact a heavy toll on Americans, who suffer about 1.5 million fractures/year, including 300,000 hip fractures. Population screening for osteoporosis has not been demonstrated to reduce fracture risk or mortality in a randomized trial, but extrapolation of results from interventional osteoporosis trials in men and women treated pharmacologically show impressive reductions in vertebral fractures (approximately one-third), hence the support from various agencies with interest in osteoporosis and its consequences.

The National Osteoporosis Foundation (NOF) suggests screening be routinely performed with bone mineral density (BMD) at age 65 in women and 70 in men, as well as men and women aged 50-69 with risk factors (such as menopause, corticosteroid use, positive family history, prior fracture, and positive FRAX score).

In persons with low BMD, NOF Guidelines suggest vertebral imaging dependent on age and other specific risk factors (e.g., low-trauma fracture during adulthood, height loss, or long-term steroid use).

Not all voices are in harmony with NOF. For instance, the U.S. Preventive Task Force rated osteoporosis screening in men, regardless of age as “I”: insufficient evidence to recommend for or against. No large randomized trial of BMD screening in men or women is on the horizon, hence clinicians may have to rely upon expert advice in the interim.