US Preventive Services Task Force Recommendations

In September 2002, the US Preventive Services Task Force (USPSTF) issued recommendations for bone density testing when screening for postmenopausal osteoporosis (16). Like the recent guidelines from the NOF, AACE, NAMS, and ACOG that preceded the release of these recommendations, the USPSTF recommended that women age 65 and older be routinely screened for osteoporosis. Unlike previous guidelines that also recommended testing for postmenopausal women younger than age 65 who had risk factors for osteoporosis, the USPSTF limited their recommended for screening in younger postmenopausal women to those women ages 60 to 64 who were at high risk for osteoporosis. They made no comment on screening for postmenopausal women younger than age 60. The USPSTF also noted that there was no data to determine an upper age limit for screening.

In making these recommendations, the USPSTF did not direct the clinician to use a specific bone density technology or skeletal site. They also noted that the risk factors that should be considered in deciding whether to test the younger postmenopausal woman were difficult to identify. Body weight less than 154 lb (70 kg), increasing age, and no current use of estrogen were identified as strong predictors of low bone density.

The recommendations to screen women age 65 and older and women 60 to 64 at high risk for osteoporosis were classified by the USPSTF as grade B recommendations. A grade B recommendation means that the USPSTF recommends that clinicians routinely provide such services to their patients based on finding fair evidence that the service is beneficial in improving outcomes and that such benefit outweighs any potential harm. The evidence supporting these recommendations was characterized as fair on the USPSTF scale of good, fair, and poor. A characterization of fair indicates that the USPSTF believed that the evidence was sufficient to determine the effect of the service on health outcomes but was limited by one or a number of factors.

The evidence reviewed by the USPSTF predominantly came from searches of MEDLINE spanning 1966 to May 2001, HealthSTAR spanning 1975 to May 2001, and Cochrane databases (17). No studies were identified that directly linked screening for postmenopausal osteoporosis using risk factors or bone densitometry to a reduction in osteoporotic fractures. It was primarily for this reason that the evidence for the screening recommendations from the USPSTF was characterized as fair rather than good. Numerous studies were identified that evaluated the associations between risk factors and low bone density and fractures as well as studies documenting the predictive ability of bone densitometry for fracture risk. The USPSTF also reviewed published trials of the therapeutic agents approved by the FDA for either the prevention or treatment of postmeno-pausal osteoporosis or both.

Based on their review, the USPSTF estimated the effectiveness of screening 10,000 women with densitometry in reducing hip and spine fractures. The results are shown in

Table 7-6

Screening for Osteoporosis in 10,000 Postmenopausal Women: Hip and Vertebral Fracture Outcomes by 5-Year Age Intervals

Table 7-6

Screening for Osteoporosis in 10,000 Postmenopausal Women: Hip and Vertebral Fracture Outcomes by 5-Year Age Intervals

Variable

Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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