Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Disparities in Osteoporosis Screening in US Women

Am J Med; 2017 Mar; Gillespie, Morin, et al

Publish date:

Substantial deficiencies in osteoporosis screening among women aged ≥65 years in the US remain, despite significant changes in utilization of screening among women ages 50 to 64 years and ≥80 years, a recent study found. This retrospective analysis from 2008 to 2014 included 1,638,454 women aged ≥50 years with no prior history of osteoporosis diagnosis, osteoporosis drug use, or hip fracture. Osteoporosis screening during the most recent 2-year period of continuous enrollment was assessed. Researchers found:

  • Overall screening rates were low: 21.2%, 26.5%, and 12.8% among women aged 50-64, 65-79, and ≥80 years, respectively.
  • Utilization among women aged 50-64 years declined 31.4% between 2008 and 2014; changed little among women aged 65-79 years, and increased 37.7% among women ≥80 years.
  • Non-Hispanic black women were least likely to be screened, whereas non-Hispanic Asian and Hispanic women were most likely to undergo screening.
  • Socioeconomic gradients in screening probabilities narrowed substantially over time.

Citation:

Gillespie CW, Morin PE. Trends and disparities in osteoporosis screening among women in the United States, 2009-2014. Am J Med. 2017;130(3):306-316. doi:10.1016/j.amjmed.2016.10.018.

Commentary:

The USPSTF recommends screening for osteoporosis in women aged 65 years and older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors.1 Similar recommendations are given by the National Osteoporosis Foundation.2 Utilizing the US FRAX calculator, which is helpful in assessing osteoporotic fracture risk, a 65-year-old white woman with no other risk factors has a 9.3%, 10-year risk for any osteoporotic fracture. The rationale for screening is that one-half of all postmenopausal women will have an osteoporosis-related fracture, of whom 15% will have a hip fracture. Treatment includes adequate calcium and vitamin D intake, weight-bearing exercise, and medications, most often bisphosphonates. Such treatment with medications can reduce the risk for fractures. According to the current study, screening for osteoporosis is something we should be recommending more often. —Neil Skolnik, MD

  1. US Preventive Services Task Force. Final recommendation statement. Osteoporosis: Screening. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/osteoporosis-screening. Accessed March 2, 2017.
  2. Cosman F, de Beur SJ, LeBoff MS, et al. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014;25:2359-2381. doi:

This Week's Must Reads

Must Reads in Preventive Care