USPSTF Screening Guidelines

New Expanded Osteoporosis Screening Guidelines

It’s interesting that the USPSTF is publishing new guidelines for screening of osteoporosis just as more questions develop about the long term treatment of osteoporosis with bisphosphonates.  In the first USPSTF recommendation update that’s been released after the new protocol for posting anticipated updates for public comment, the task force now gives a Grade B recommendation for osteoporosis screening for all women age 65 or older, as well as for younger women who are estimated to have a risk as high or higher than  a 65 year old woman with no additional risk factors.

The statement specifically recommends DEXA screening of the hip and lumbar spine, but and even recommends a tool to use to assess risk in younger women called the FRAX Risk Assessment Tool.

No recommendation (Grade I: insufficient evidence) is given to screening for men.

There has been a lot written about the risks of atypical femur fractures and osteonecrosis of the jaw in long term treatment with bisphosphonates.  The benefits of these drugs seems to outweigh these risks in general.  Still it is not clear how long we should use these drugs, and whether the benefits are lasting after a several year course of treatment, or only last as long as treatment continues.  Clearly there is more research needed to answer these questions.

The task force also gives no specific guidelines as to how to assess the risk for women age less than 65.  Generally considered risk factors for osteoporosis include smoking, thyroid therapy, corticosteroid treatment, thin body habitus, poor calcium intake, sedentary lifestyle, and prior fractures.

My practice has been to try to screen women in the 50-65 age range if they have multiple risk factors or at 65 if not.  I’ll continue this routine, but it’s good to have the new recommendation as it will make Medicare coverage for DEXA a preventative service, I believe with no co-pay or deductible.  Comments as to experience with this issue are welcome on this medical blog.

2 Responses to USPSTF Screening Guidelines

  1. Osteoporosis is a problem that is showing up in younger and younger populations due to a number of issues. One of those issues is nutritional: Drink Soda? Soda pop (diet or regular makes no difference) can contribute to osteoporosis! How is that? Well, a chemical that can cause Calcium/Phosphorus to LEECH OUT of our bone mass is phosphoric acid, which is found in soda pop!

    If you drink a lot (or more than 1-2 cans/day) of soda pop, you might consider loosing that soda or at least cutting down on how much you drink in an average day.

    Caffeine can also increase the flux of Calcium and Phosphorus OUT of bone.

    So think twice before you say, ‘I’ll have another!’ Soda pop also:

    * Provides sugar (food) to harmful bacteria and yeast causing acidity in blood which leeches Ca/P out of bone, causing immune reactions in gut that inflame gut wall, causing harmful gut material to leak into blood, and causing the immune system to become more sensitive and become more allergic.

    * Injects phosphoric acid into blood, which leeches Ca/P out of bone.

    * The Phosphoric Acid in soda leeches metal out of dental amalgam, especially copper Amalgam used in Finland, Norway, and Germany prior 1980.

    Also note that one can hit a viscous cycle, in that their ATP energy can become impaired (fatigue), they can reach for a soda to give them a little boost and further hurt their health via the above interactions, causing them to reach for another soda…

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