Viswanathan M, et al. - In the present study, the evidence on screening and treatment to prevent osteoporotic fractures for the US Preventive Services Task Force was reviewed. Findings suggested that screening to prevent osteoporotic fractures might decrease hip fractures, and treatment lessened the risk of vertebral and nonvertebral fractures in women. No consistent evidence of treatment harms was found. For identifying osteoporosis or predicting fractures, the accuracy of bone measurement tests or clinical risk assessments varied from very poor to good.

Methods

• For this analysis, researchers searched PubMed, the Cochrane Library, EMBASE, and trial registries (November 1, 2009 through October 1, 2016) and surveilled the literature (through March 23, 2018) and bibliographies from articles.
• Study participants were adults 40 years and older, screening cohorts without prevalent low-trauma fractures or treatment cohorts with increased fracture risk, and studies assessing screening, bone measurement tests or clinical risk assessments, pharmacologic treatment.
• Incident fractures and related morbidity and mortality, diagnostic and predictive accuracy, harms of screening or treatment were the main outcomes and measures.

Results

• One hundred sixty-eight fair- or good-quality articles were incorporated in this analysis.
• It was observed that one randomized clinical trial (RCT) (n = 12,483) that compared screening vs no screening reported fewer hip fractures (2.6% vs 3.5%; hazard ratio [HR], 0.72 [95% CI, 0.59-0.89]), but no other statistically significant benefits or harms.
• It was noted that the accuracy of bone measurement tests to identify osteoporosis was mixed (area under the curve [AUC], 0.32-0.89).
• The pooled accuracy of clinical risk assessments for identifying osteoporosis ranged from AUC of 0.65 to 0.76 in women and from 0.76 to 0.80 in men, with the accuracy for predicting fractures being similar.
• Bisphosphonates, parathyroid hormone, raloxifene, and denosumab were correlated with a lower risk of vertebral fractures (9 trials [n = 23,690]; relative risks [RRs] from 0.32-0.64) in women.
• It was found that bisphosphonates (8 RCTs [n = 16,438]; pooled RR, 0.84 [95% CI, 0.76-0.92]) and denosumab (1 RCT [n = 7868]; RR, 0.80 [95% CI, 0.67-0.95]) were correlated with a lower risk of nonvertebral fractures.
• Findings revealed that denosumab decreased the risk of hip fracture (1 RCT [n = 7868]; RR, 0.60 [95% CI, 0.37-0.97]), but bisphosphonates did not have a statistically significant association (3 RCTs [n = 8988]; pooled RR, 0.70 [95% CI, 0.44-1.11]).
• Zoledronic acid reduced the risk of radiographic vertebral fractures (1 RCT [n = 1199]; RR, 0.33 [95% CI, 0.16-0.70]) in men, and no studies showed reductions in clinical or hip fractures.
• The present data indicated that bisphosphonates were not consistently correlated with reported harms other than deep vein thrombosis (raloxifene vs placebo; 3 RCTs [n = 5839]; RR, 2.14 [95% CI, 0.99-4.66]).