Screening Decision Tools
When should screening for osteoporosis be performed? The decision to order bone mineral density test should be based on patient age and risk factors. A number of risk assessment tools have been developed to help determine when screening is warranted.
Developed by the World Health Organization, FRAX is a fracture risk assessment tool that allows for calculation of future risk of fracture based on patient characteristics. The testing threshold is country specific.
The United States Preventive Services Task Force (USPSTF) recommends using FRAX to calculate risk with subsequent testing of the following groups:
- All women 65 and older
- Women 50-64 with 10-year risk of fracture of 9.3% or more
Persons with a know fragility fracture and certain high risk medical conditions that predispose to osteoporosis should be screened regardless of their FRAX-estimated risk.
Treatment Decision Tools
When is it cost-effective to begin treatment to prevent future fractures?
In the United States, the National Osteoporosis Foundation Guidelines recommend treatment of individuals with the following:
- A fragility fracture of the hip or vertebrae
- T-score < -2.5 at the femoral neck or spine
- T-score -1.0 to -2.4 at the femoral neck or spine AND a 10-year probability of
- Hip fracture ≥3%
major fracture ≥20%
- Hip fracture ≥3%
as calculated from the US-adapted FRAX®WHO Fracture Risk Assessment Tool algorithm.
Treatment thresholds are also country specific. The National Osteoporosis Guideline Group (NOGG) provides guidance for cost-effective care for UK-based clinicians. Individual application of these guidelines can be accessed via through the FRAX site.
- National Osteoporosis Foundation. NOF Clinician's Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2010.
- Tosteson AN, Melton LJ 3rd, Dawson-Hughes B, Baim S, Favus MJ, Khosla S,Lindsay RL; National Osteoporosis Foundation Guide Committee. Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporos Int. 2008 Apr;19(4):437-47. [Available online.]
Last updated: 9/15/11