Screening for Osteoporosis

PURPOSE: To review evidence that screening for osteoporosis by measuring bone mass in postmenopausal women would reduce fracture incidence. DATA IDENTIFICATION: An English-language literature search using MEDLINE (1966 to 1989), bibliographic reviews of book chapters and review articles, technology assessments of bone mass measurement, and other publications. STUDY SELECTION: We summarize prospective studies of fracture risk prediction done with widely used bone mass measurement techniques, and we document noncontroversial or peripheral points with recent papers and reviews. DATA EXTRACTION: Without osteoporosis screening trials, no quantitative analysis is possible. Instead, we assess the ability of screening tests to measure bone mass and define fracture risk categories, the ability of risk categories to determine treatment, and the ability of treatment to reduce fracture incidence. RESULTS OF DATA SYNTHESIS: Bone mass measurement meets many of the criteria for a screening test, and indirect evidence suggests that a screening program might reduce osteoporosis-related fracture incidence. No trial has shown this directly; however, and questions remain about overall benefits and costs of mass screening. CONCLUSIONS: Although there are clinical indications for bone mass measurement, unselective screening for osteoporosis cannot be recommended until a specific program is formulated and justified.