Screenings for osteoporotic fracture are done by measuring the patient's bone mineral density, the USPSTF said, usually discovered by dual-energy X-ray absorptiometery, or DXA, scans of the hip and spine. Doctors can also use quantitative ultrasound of the heel, the USPSTF said. But while it appears to work about as well as DXA - and has the added benefits of being cheaper and not exposing patients to ionizing radiation - current diagnostic and treatment protocols are based around DXA, the agency said. Future research that "include[s] studies to establish parameters for treatment using quantitative ultrasound as a primary screening test for osteoporosis" are required, the USPSTF said.

About half of all Americans over 50 will be at risk for osteoporotic fractures in their lifetime, according to the USPSTF. That means about 12 million people could be suffering osteoporosis by 2012. Yearly treatment costs can reach upwards of $19 billion, in 2002 dollars, the USPSTF said.


Mortality rates can be high after a hip fracture, especially for men. Although the potentially deadly injuries are rare in men, when they happen, they tend to be more fatal, with close to a third of men dying within a year of suffering a hip fracture, the USPSTF said.

To come up with the new guidelines, the USPSTF did a literature review on relevant studies published between January 2001 and December 2009. This review and the background for the new recommendations appear online in the Annals of Internal Medicine on Monday.

Although the group decided to lower the age of screening for high-risk women, it determined the evidence for screening intervals was lacking, so it refrained from making any recommendations. But the most relevant study they had access to showed no added predictive value for a bone density measurement taken eight years after the first one.

"The best we can do is quote that single study," Calonge said.

The evidence for the efficacy of screening for men also came up short. The problem is while DXA scans seem to work for men and predict fracture risk, there's not enough evidence that drugs can prevent fractures or reduce mortality, the task force said, so it's not clear screening is worthwhile.

While no trial directly compares survival rates and fracture risk between women screened and those who aren't, Calonge said they can at least build up recommendations through a "chain of evidence." Treating women with osteoporosis with certain drugs, like bisphosphonates, can decrease fracture risk, and asymptomatic women can be detected through DXA scans.

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