In an update to its 2002 recommendation, the U.S. Preventive Services Task Force now recommends that all women ages 65 and older be routinely screened for osteoporosis.

The task force also recommends that younger women with increased risk factors for osteoporosis be screened if their fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors.

In its 2002 recommendation, the group recommended screenings for women who are 60 years old and older and had an increased risk of osteoporotic fractures.

Osteoporosis, a condition that occurs when bone tissue thins or develops small holes, can cause pain, broken bones, and loss of body height. Osteoporosis is more common in women than men and is more common in whites than any other racial group. For all demographic groups, the rates of osteoporosis rise with increasing age. Risk factors for osteoporosis include tobacco use, alcohol use, low body mass, and parental history of fractures.

The task force didn't indicate a specific age limit at which screening should no longer be offered because the risk for fractures continues to increase with age, and the evidence indicates that benefits can be realized within 18 to 24 months after starting treatment. The group also looked at whether to recommend screening men for osteoporosis but found insufficient evidence to make a recommendation at this time. This new final recommendation became effective when it appeared in the Jan. 18 online issue of Annals of Internal Medicine and will also be available on the task force's website.

"As the number of people over the age of 65 in the U.S. increases, osteoporosis screening continues to be important in detecting women at risk who will benefit from treatment to prevent fractures," says task force chairman Dr. Ned Calonge, who also is the president and CEO of The Colorado Trust. "Clinicians also should talk to their younger patients to learn if they have risk factors that mean they should be screened."

Osteoporosis screening involves a measurement of bone density, a procedure that's currently covered by Medicare. The most commonly used bone density measurement tests are dual-energy X-ray absorptiometry of the hip and lumbar spine, as well as quantitative ultrasound of the heel, although current diagnostic and treatment criteria are based on dual-energy X-ray tests alone. The task force notes that there is a lack of evidence about how often screening should be repeated in women whose first test is negative.

In postmenopausal women who have no prior fractures caused by osteoporosis, the task force found convincing evidence that drug therapies, including bisphosphonates, parathyroid hormone, raloxifene, and estrogen, reduce the risk for osteoporosis-related fractures.

The task force is an independent panel of private-sector experts in prevention and evidence-based medicine that conducts rigorous, impartial assessments of the scientific evidence and makes recommendations on the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications. The task force doesn't consider costs or cost-effectiveness in creating recommendations. The Agency for Healthcare Research and Quality (AHRQ) is authorized by statute to convene the group and provide scientific and administrative support. The task force didn't indicate a specific age limit at which screening should no longer be offered because the risk for fractures continues to increase with age.