New Guidance Aids Osteoporosis Screening

Dr. Edward S. Leib also commended inclusion of the FRAX tool in the guidelines, but cautioned that it has some weaknesses that were discussed at a November 2010 “position development conference” conducted jointly by the International Osteoporosis Foundation and the International Society for Clinical Densitometry.

Some important risk factors that could affect the 10-year fracture risk would not necessarily be reflected in the FRAX calculation, he said. In addition, the FRAX tool is based on an international model, and although it included U.S. databases, the calculations may not reflect risks in regional populations.

“For example, in a retrospective review of our population of 15,000 postmenopausal women having bone density studies over the past 10 years, we did not find a correlation between history of fracturing and parental history of hip fractures,” he said.

Both Dr. Crandall and Dr. Leib also commended the USPSTF for acknowledging the need for more research in men, but Dr. Leib had hoped for more guidance. “It is known that the fracture risk in men who are age 75 is about equivalent to women who are age 65. I would have hoped that the USPSTF would have recommended screening at that age” despite the lack of primary prevention trials, he said.

DR. CRANDALL is professor of medicine at the University of California, Los Angeles. She said she has no pertinent conflicts of interest. DR. LEIB is professor of medicine at the University of Vermont, Burlington. He said he has no pertinent conflicts of interest.