Clinical Summary

Osteoporosis to Prevent Fractures: Screening

June 26, 2018

Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

Population Women 65 years and older Postmenopausal women younger than 65 years at increased risk Men
Recommendation Screen for osteoporosis.
Grade: B
Screen for osteoporosis.
Grade: B
No recommendation.
Grade: I (insufficient evidence)
Risk Assessment Risk factors for osteoporotic fractures include parental history of hip fracture, smoking, excess alcohol consumption, and low body weight. In addition, menopausal status in women is also an important consideration. For postmenopausal women younger than 65 years who have at least 1 risk factor, a reasonable approach to determine who should be screened with bone measurement testing is to use a clinical risk assessment tool. Several tools are available to assess osteoporosis risk, such as OST, ORAI, OSIRIS, SCORE, and FRAX.
Screening Tests The most commonly used test is central dual-energy x-ray absorptiometry (DXA) of the hip and lumbar spine. While several bone measurement tests similarly predict risk of fractures, DXA provides measurement of bone mineral density (BMD), and most treatment guidelines use central DXA to define osteoporosis and the treatment threshold to prevent osteoporotic fractures. Other screening tests include peripheral DXA and quantitative ultrasound (QUS).
Treatments The US Food and Drug Administration has approved multiple drug therapies to reduce osteoporotic fractures, including bisphosphonates, parathyroid hormone, raloxifene, and estrogen. The choice of therapy should be an individual one based on the patient's clinical situation and the tradeoff between benefits and harms.
Other Relevant USPSTF Recommendations The USPSTF has made recommendations on interventions to prevent falls in community-dwelling older adults and the use of vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults.

For a summary of the evidence systematically reviewed in making these recommendations, the full recommendation statement, and supporting documents, please go to