MJA: Osteoporosis consensus statement, Australia 1997

The prevention and management of osteoporosis
Consensus statement

5. Is screening of the general population or high risk groups for osteoporosis effective or cost-effective?

Mass screening

Mass screening for low bone density by densitometry or ultrasound is not advocated for a variety of reasons.

The likelihood of poor attendance at screening programs, poor uptake and compliance with therapy, and a relatively low efficacy of available treatments (30%-50%) suggest that the cost of a mass screening program would not be justified by the resulting change in the incidence of fractures in the whole community.

For cost-effective intervention, the cost of screening and treating large numbers of people must be outweighed by the reduction in events and increase in quality of life in those identified to be at risk who may subsequently take treatment. The paucity of high quality current data on costs and cost-effectiveness does not allow the identification of an appropriate screening strategy.

Individual assessment

Bone density measurement is necessary when it is likely to affect treatments offered to or accepted by an individual. It would appear to be unnecessary to test bone density in a woman who has decided to take oestrogens for other reasons. By contrast, when there is indecision, bone density measurement will allow the postmenopausal woman at low risk to avoid costly long-term interventions. Some of the clinical indications for bone density measurement are the predictors of risk listed in Question 3.

Genetics

Inherited factors appear to play a major role in determining peak bone mass. Although the mechanism of such effects remains unclear, these factors form an important component of risk assessment. In particular, careful questioning about fractures and/or kyphosis in older family members (male and female) should be a routine part of any review of osteoporosis risk.

Next: What interventions are effective in preventing osteoporosis and osteoporotic fractures?

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