USPSTF Recommendation: Osteoporosis Screening for Women 65 Years of Age or Older to Prevent Fractures

Osteoporotic fractures are associated with significant health consequences, including psychological distress, subsequent fractures, loss of independence, reduced ability to perform daily activities, and increased mortality risk. To address these challenges, the US Preventive Services Task Force (USPSTF) conducted a systematic review to assess the benefits and risks of osteoporosis screening in adults aged 40 years or older who have no previous diagnosis of osteoporosis or history of fragility fractures.

Based on its review, the USPSTF concluded with moderate certainty that screening for osteoporosis to prevent fractures provides a moderate net benefit for two populations. First, women aged 65 years or older should undergo screening, as this group has a significant risk of osteoporotic fractures, and the benefits of early detection and intervention outweigh the harms. Second, postmenopausal women younger than 65 years who are identified as being at increased risk of osteoporotic fractures through clinical risk assessment also benefit moderately from screening. For these populations, the USPSTF issued a B recommendation, reflecting moderate certainty of moderate net benefit.

In contrast, the USPSTF found the evidence insufficient to determine the balance of benefits and harms of screening for osteoporosis in men. While men may also experience osteoporotic fractures, data on the efficacy and potential harms of screening in this population remain limited.

This recommendation updates the 2018 USPSTF guidelines on osteoporosis screening. In the 2018 recommendation, the USPSTF advised screening for osteoporosis using bone measurement testing in women aged 65 years or older and in postmenopausal women younger than 65 years at increased risk of osteoporosis, as identified by formal clinical risk assessment tools.

In the current recommendation, the USPSTF clarifies that screening methods may include dual-energy x-ray absorptiometry bone mineral density testing, either alone or in combination with fracture risk assessments. Overall, the updated guidance remains consistent with the 2018 recommendation but expands on the potential approaches for screening.

Reference
US Preventive Services Task Force, Nicholson WK, Silverstein M, et al. Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. JAMA. Published online January 14, 2025. doi:10.1001/jama.2024.27154