USPSTF Reaffirms Osteoporosis Screening Recommendations

Osteoporosis occurs when bone mass and bone mineral density decline. The decrease in bone strength can increase the risk of fractures, most commonly of the spine (vertebrae), hip (femoral neck) or wrist. Osteoporotic fractures can lead to pain, disability and an increased risk of death, for example after a hip fracture.[1]

Risk factors for osteoporosis include female sex, increasing age beyond 65 years, a family history of osteoporosis, excessive alcohol use, smoking, being underweight, and the long-term use of certain medications such as corticosteroids and proton pump inhibitors.[2]

Osteoporosis is usually not associated with symptoms and is often diagnosed after a fracture occurs.[3] In some situations, screening for osteoporosis may identify patients at increased risk. Osteoporotic fractures are fragility fractures, meaning they occur in situations that would not break a healthy bone, such as following mild trauma or a severe cough.

The updated recommendations

In January 2025 the U.S. Preventive Services Task Force (USPSTF) updated its 2018 recommendations for osteoporosis screening (see Table, below).[4] The recommendations are based on a systemic review of the benefits and harms of screening for osteoporosis to prevent fractures in adults who are 40 years or older and had no osteoporosis diagnosis or history of osteoporotic fractures. The recommendations are not for individuals with secondary osteoporosis (for example, osteoporosis caused by underlying medical conditions, such as cancer, or by taking medications that can cause bone loss).

For the update, the USPSTF also included evidence from three randomized controlled trials with more than 57,700 participants.[5] For the participants who were screened for osteoporosis, their primary care physician determined follow-up care based on the screening results. The other groups received only routine care. Those who received osteoporosis screening had a significantly lower risk of fractures than those who were not screened. For instance, over four to five years, there were an average of five fewer hip fractures for every 1,000 screened participants and six fewer major osteoporotic fractures.

Table 1. USPSTF Osteoporosis Screening Recommendations to Prevent Fractures*

*These recommendations do not apply to individuals with a prior osteoporosis diagnosis, a history of osteoporotic fractures, or secondary or drug-induced osteoporosis.

For women 65 years or older, the USPSTF concluded with moderate certainty that screening to prevent osteoporotic fractures had a moderate net benefit. The panel also concluded that measuring bone mineral density with a test called dual-emission X-ray absorptiometry (DXA) can accurately predict osteoporotic fractures. DXA is routinely used to measure bone mineral density at central bone sites, for example at the hip, lumbar spine or femoral neck.

In postmenopausal women younger than 65 years, the panel recommended that clinicians determine whether additional risk factors for osteoporosis (as discussed above) are present to determine which individuals would benefit from screening. For postmenopausal women younger than 65 years with one or more additional risk factors, screening was found to also have a moderate net benefit. For women younger than 65 years without additional risk factors, the USPSTF did not issue a recommendation. The USPSTF also found that for women for whom screening was recommended, the potential harms of screening were small.

For men, the USPSTF concluded that the benefits and harms of osteoporosis screening were inconclusive. The task force recommended that clinicians use clinical judgment to determine whether certain men would benefit from screening.

Discussion of the updated guidelines

The updated USPSTF guidelines are similar to the panel’s 2018 recommendation.[6] Although in 2018 the USPSTF recommended that clinicians use a clinical-risk assessment tool to screen postmenopausal women younger than 65 years, the updated recommendation suggests first identifying risk factors for an increased risk of osteoporosis.[7] Moreover, although screening in 2018 was broadly characterized as “bone measurement testing,” the updated guideline specifically recommends central-site DXA regardless of the use of other risk-assessment tools.[8]

The USPSTF also identified several gaps in the available research.[9] For example, due to a lack of evidence, the task force could not recommend an optimal interval between screenings. The panel also cautioned that, especially in younger people, measuring bone mineral density may not be a reliable predictor of fracture risk. Moreover, there are inadequate data about potential racial and ethnic differences in fracture risk.[10]

The recommendation also does not address potential long-term harms associated with osteoporosis drug treatments. These limitations of the updated guidelines are particularly relevant for younger postmenopausal women, for whom harms associated with drug treatment may not outweigh the moderate benefits.[11]

What You Can Do

Speak to your clinician about screening for osteoporosis. Be aware that certain lifestyle approaches not only help prevent osteoporosis but also can be used to treat it.[12] These approaches include weight-bearing and balance-maintaining exercises, adequate calcium and vitamin D intake, no or low alcohol consumption, and smoking cessation. Take measures to reduce your risk of sustaining a fracture by preventing falls, such as avoiding medications that cause sedation when possible and reducing falling hazards in your home (for example, loose rugs or cables).

If your clinician recommends drug treatment because you have osteoporosis and are at high risk of fracture, consider bisphosphonates such as alendronate (BINOSTO, FOSAMAX and generics), ibandronate (generics only) and risedronate (ACTONEL, ATELVIA and generics) as initial treatments. Because these drugs are associated with serious adverse events, Public Citizen’s Health Research Group has designated them as Limited Use.[13]
 

References

[1] National Institute on Aging. Osteoporosis. November 15, 2022. https://www.nia.nih.gov/health/osteoporosis/osteoporosis. Accessed June 9, 2022.

[2] Drugs associated with osteoporosis and related fractures. Worst Pills, Best Pills News. January 2024. https://www.worstpills.org/newsletters/view/1574. Accessed June 9, 2025.

[3] National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteoporosis. December 2022. https://www.niams.nih.gov/health-topics/osteoporosis. Accessed June 9, 2025.

[4] U.S. Preventive Services Task Force; Nicholson WK, Silverstein M, et al. Screening for osteoporosis to prevent fractures: US Preventive Services Task Force recommendation statement. JAMA. 2025 Feb 11;333(6):498-508.

[5] U.S. Preventive Services Task Force; Nicholson WK, Silverstein M, et al. Screening for osteoporosis to prevent fractures: US Preventive Services Task Force recommendation statement. JAMA. 2025 Feb 11;333(6):498-508.

[6] Ibid.

[7] Ott SM. Research that could broaden the scope of bone density screening. JAMA Netw Open. 2025 Jan 2;8(1):e2460746.

[8] Ensrud KE, Crandall CJ. Fracture risk assessment as a component of osteoporosis screening-easier said than done. JAMA. 2025 Feb 11;333(6):468-469.

[9] Ibid.

[10] Ott SM. Research that could broaden the scope of bone density screening. JAMA Netw Open. 2025 Jan 2;8(1):e2460746.

[11] Ensrud KE, Crandall CJ. Fracture risk assessment as a component of osteoporosis screening-easier said than done. JAMA. 2025 Feb 11;333(6):468-469.

[12] National Institute on Aging. Osteoporosis. November 15, 2022. https://www.nia.nih.gov/health/osteoporosis/osteoporosis. Accessed June 9, 2022.

[13] Oral bisphosphonates for osteoporosis: Important warnings. Worst Pills, Best Pills News. October 2021. https://www.worstpills.org/newsletters/view/1425. Accessed June 17, 2025.