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Review Updates Evidence on Osteoporosis Screening

Analysis of literature reveals paucity of data on effectiveness, harm, optimal intervals

TUESDAY, July 6 (HealthDay News) -- Screening methods are available to predict risk of osteoporotic fractures, and medications to reduce fractures are effective, but studies have yet to directly identify the effectiveness or potential harm of screening or establish ideal screening intervals, according to a review published online July 5 in the Annals of Internal Medicine.

Heidi D. Nelson, M.D., of the Oregon Health & Science University in Portland, and colleagues performed a review to update evidence since the U.S. Preventive Services Task Force recommendation on osteoporosis screening. They reviewed studies on medications, validated risk-assessment instruments, bone measurement tests, and medication harm to determine the effectiveness and harms of osteoporosis screening, the performance of tests used to identify osteoporosis, optimal screening intervals, and efficacy and harms of medication therapy.

The researchers found both simple and complex risk-assessment instruments to be modest predictors of low bone density and fractures. Dual-energy X-ray absorptiometry was found to predict fractures equally well for men and women, and calcaneal quantitative ultrasonography also predicted fractures, but its correlation with dual-energy X-ray absorptiometry was only fair. The authors write that bisphosphonates, parathyroid hormone, raloxifene, and estrogen reduced primary vertebral fractures in postmenopausal women. Raloxifene and estrogen, however, increased thromboembolic events, and estrogen was found to have other adverse effects. They also note that more research, particularly trials enrolling men, is needed.

"Although methods to identify risk for osteoporotic fractures are available and medications to reduce fractures are effective, no trials directly evaluate screening effectiveness, harms, and intervals," the authors write.

The lead author disclosed a financial relationship with Merck.

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