The 2018 US Preventive Services Task Force (USPSTF) osteoporosis screening statement1 includes separate B recommendations (moderate certainty of moderate net benefit) for bone density screening in women 65 years or older and in postmenopausal women younger than 65 years who are at increased risk of osteoporosis, as determined by a formal clinical risk assessment tool. The B recommendation for routine osteoporosis screening in all women 65 years or older has been an enduring and evidence-based feature of the USPSTF recommendations since 2002. Unfortunately, the B recommendation for a 2-step strategy of risk-factor assessment before bone-density testing in postmenopausal women younger than 65 years does not match existing evidence. Instead, the evidence for 2-step osteoporosis screening in women younger than 65 years would be better characterized by an I statement; ie, the evidence is insufficient to determine the balance between benefits and harms.
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Gourlay ML. Osteoporosis Screening—2 Steps May Be Too Much for Women Younger Than 65 Years. JAMA Intern Med. 2018;178(9):1159–1160. doi:10.1001/jamainternmed.2018.2776
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