All women aged 65 and older should have osteoporosis screening with bone measurement testing. The USPSTF found convincing evidence that bone measurement tests accurately detect osteoporosis and predict osteoporotic fractures.
Women younger than 65 should be screened if they have the following risk factors as the benefit of treatment in preventing fractures is moderate:
· parental history of hip fracture
· excessive alcohol consumption
· low body weight
· long-term corticosteroid use
· previous fractures
· falls in the last year
Men should not be screened routinely unless they have additional risk factors.
Bone measurement techniques have varying degrees of accuracy and central DXA scanning is the established standard for diagnosing osteoporosis and guiding treatment decisions.
The peripheral DXA may increase access to osteoporosis screening but scanning at the calcaneus may be less accurate vs central DXA scanning.
The harms associated with osteoporosis medications is small and the serious adverse events associated with bisphosphonates, the most commonly used osteoporosis medications, include upper gastrointestinal and cardiovascular events.