Is osteoporosis screening in postmenopausal women effective?

Journal of Family Practice, April, 2003 by John Phillips, Alex Krist, Laura Wilder, Michael L. Lefevre

TABLE

Hip and vertebral fracture outcomes for osteoporosis
screening in 10,000 postmenopausal women (9)

                                                  Age (years)

Screening outcomes                        55-59      65-69      75-79

Identified with osteoporosis               445       1200       2850
Hip fracture prevented with medication      2         14         70
NNS to prevent 1 hip fracture             4338        731        143
NNT to prevent 1 hip fracture              193        88         41
Vertebral fractures prevented               7         40         134
NNS to prevent 1 vertebral fracture       1338        248        75
NNT to prevent 1 vertebral fracture        60         30         21

The calculations in this table assume that treatment reduces the
risk of vertebral fracture by 48%, the risk of hip fracture to 36%,
and that 70% of patients will adhere to therapy. Table modified from
USPSTF report. (9)

NNS. number needed to screen for benefit; NNT number needed to treat
for benefit

REFERENCES

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(2.) Cooper C, Atkinson EJ, Jacobsen SJ, O'Fallon WM, Melton LJ 3rd. Population-based study of survival after osteoporotic fractures. Am J Epidemiol 1993; 137:1001-1005.

(3.) Cummings SR, Nevitt MC, Browner WS, et al. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 1995; 332:767-773.

(4.) Cadarette SM, Jaglal SB, Kreiger N, McIsaac WJ, Darlington GA, Tu JV. Development and validation of the Osteoporosis Risk Assessment Instrument to facilitate selection of women for bone densitometry. CMAJ 2000; 162:1289-1294.

(5.) Cadarette SM, Jaglal SB, Murray TM, McIsaac WJ, Joseph L, Brown JP. Evaluation of decision rules for referring women for bone densitometry by dual-energy x-ray absorptiometry.JAMA 2001: 286:57-63.

(6.) Marshall D, Johnell O, Wedel H. Meta analysis of how well measures of bone marrow density predict occurrence of osteoporotic fractures. BMJ 1996; 312:1254-1259.

(7.) Cranney A, Tugwell P, Adachi J, et al. Meta-analyses of therapies for postmenopausal osteoporosis. III. Meta-analysis of risedronate for the treatment of postmenopausal osteoporosis. Endocr Rev 2002; 23:517-523.

(8.) Cummings SR, Black DM, Thompson DE, et al. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 1998; 280:2077-2082.

(9.) Nelson HD, Helfand M, Woolf SH, Allan JD. Screening for postmenopausal osteoporosis: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2002; 137:529-541.

(10.) Physicians Guide to Prevention and Treatment of Osteoporosis. National Osteoporosis Foundation. Washington, DC: National Osteoporosis Foundation; 1999. Available at: www.nof.org/physguide. Accessed on February 24, 2003.