A Comparison of U.S. and Canadian Osteoporosis Screening and Treatment Strategies in Postmenopausal Women.
J Bone Miner Res. 2018 Dec 07;: Authors: Crandall CJ, Larson J, Manson JE, Cauley JA, LaCroix A, Wactawski-Wende J, Datta M, Sattari M, Schousboe JT, Leslie WD, Ensrud KE
The optimal approach to osteoporosis screening and treatment in postmenopausal women is unclear. We compared 1) the United States Preventive Services Task Force (USPSTF) and Osteoporosis Canada osteoporosis screening strategies; and 2) the National Osteoporosis Foundation (NOF) and Canadian treatment strategies. We used data from the prospective Women's Health Initiative Observational Study and Clinical Trials of women aged 50-79 years at baseline (n = 117,707 followed for self-reported fractures; n = 8,134 in bone mineral density [BMD] subset). We determined the yield of the screening and treatment strategies in identifying women who experienced major osteoporotic fractures (MOF) during 10-year follow-up. Among women aged 50-64 years, 23.1% of women were identified for BMD testing under the USPSTF strategy and 52.3% under the Canadian strategy. For women ≥65 years, 100% were identified for testing under the USPSTF and Canadian strategies, 35-74% were identified for treatment under NOF, and 16-37% were identified for treatment under CAROC (range among 5-year age subgroups). Among women who experienced MOF during follow-up, the USPSTF strategy identified 6.7% of women 50-54 years-old and 49.5% of women 60-64 years-old for BMD testing (versus 54.4% and 60.6% for the Canadian strategy, respectively). However, specificity of the USPSTF strategy was higher than that of the Canadian strategy among women 50-64 years-old. Among women who experienced MOF during follow-up, sensitivity for identifying women as treatment candidates was lowest for both strategies in women aged 50-64 (NOF 10-38%; CAROC 1-15%) and maximal in 75- to 79-year-old women (NOF 82.8%; 51.6% CAROC); specificity declined with advancing age and was lower with the NOF than the CAROC strategy. Among women aged 50-64 years, the screening and treatment strategies examined had low sensitivity for identifying those who subsequently experience MOF; sensitivity was higher among women ≥65 years than among younger women. New screening and treatment algorithms are needed. This article is protected by copyright. All rights reserved. PMID: 30536628 [PubMed - as supplied by publisher]