Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, USA.
Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
J Bone Miner Res. 2019 Apr;34(4):607-615. doi: 10.1002/jbmr.3636. Epub 2019 Jan 15.
The optimal approach to osteoporosis screening and treatment in postmenopausal women is unclear. We compared (i) the United States Preventive Services Task Force (USPSTF) and Osteoporosis Canada osteoporosis screening strategies; and (ii) the National Osteoporosis Foundation (NOF) and Canadian treatment strategies. We used data from the prospective Women's Health Initiative Observational Study and Clinical Trials of women aged 50 to 79 years at baseline (n = 117,707 followed for self-reported fractures; n = 8134 in bone mineral density [BMD] subset). We determined the yield of the screening and treatment strategies in identifying women who experienced major osteoporotic fractures (MOFs) during a 10-year follow-up. Among women aged 50 to 64 years, 23.1% of women were identified for BMD testing under the USPSTF strategy and 52.3% under the Canadian strategy. For women ≥65 years, 100% were identified for testing under the USPSTF and Canadian strategies, 35% to 74% were identified for treatment under NOF, and 16% to 37% were identified for treatment under CAROC (range among 5-year age subgroups). Among women who experienced MOF during follow-up, the USPSTF strategy identified 6.7% of women 50 to 54 years-old and 49.5% of women 60 to 64 years-old for BMD testing (versus 54.4% and 60.6% for the Canadian strategy, respectively). However, the specificity of the USPSTF strategy was higher than that of the Canadian strategy among women 50 to 64 years-old. Among women who experienced MOF during follow-up, sensitivity for identifying women as treatment candidates was lowest for both strategies in women aged 50 to 64 (NOF 10% to 38%; CAROC 1% to 15%) and maximal in 75-year-old to 79-year-old women (NOF 82.8%; 51.6% CAROC); specificity declined with advancing age and was lower with the NOF compared to the CAROC strategy. Among women aged 50 to 64 years, the screening and treatment strategies examined had low sensitivity for identifying those who subsequently experience MOF; sensitivity was higher among women ≥65 years than among younger women. New screening and treatment algorithms are needed. © 2018 American Society for Bone and Mineral Research.
绝经后妇女骨质疏松症筛查和治疗的最佳方法仍不明确。我们比较了（i）美国预防服务工作组（USPSTF）和加拿大骨质疏松症协会的骨质疏松症筛查策略；以及（ii）国家骨质疏松基金会（NOF）和加拿大的治疗策略。我们使用了前瞻性妇女健康倡议观察研究和基线时年龄在 50 至 79 岁的女性临床试验的数据（n=117707 例，随访期间报告骨折；n=8134 例，行骨密度[BMD]亚组检查）。我们确定了这些筛查和治疗策略在识别 10 年随访期间发生主要骨质疏松性骨折（MOF）的女性中的作用。在 50 至 64 岁的女性中，USPSTF 策略下有 23.1%的女性进行了 BMD 检测，加拿大策略下有 52.3%的女性进行了检测。对于年龄≥65 岁的女性，USPSTF 和加拿大策略下 100%的女性接受了检测，NOF 下有 35%至 74%的女性接受了治疗，CAROC 下有 16%至 37%的女性接受了治疗（5 岁年龄亚组之间的差异）。在随访期间发生 MOF 的女性中，USPSTF 策略识别出 50 至 54 岁女性中有 6.7%和 60 至 64 岁女性中有 49.5%进行 BMD 检测（分别为加拿大策略下的 54.4%和 60.6%）。然而，USPSTF 策略的特异性高于加拿大策略。在随访期间发生 MOF 的女性中，两种策略在 50 至 64 岁女性中识别出治疗候选者的敏感性均最低（NOF 为 10%至 38%；CAROC 为 1%至 15%），在 75 岁至 79 岁女性中最高（NOF 为 82.8%；CAROC 为 51.6%）；特异性随年龄增长而下降，与 CAROC 策略相比，NOF 策略的特异性较低。在 50 至 64 岁的女性中，所检查的筛查和治疗策略识别随后发生 MOF 的女性的敏感性较低；≥65 岁女性的敏感性高于年轻女性。需要新的筛查和治疗算法。© 2018 美国骨矿研究协会。
