[Automatically generated] From the JAMA Network, this is JAMA Clinical Reviews, interviews and ideas about innovations in medicine, science, and clinical practice. Hello, and welcome to this JAMA Clinical Reviews podcast. I'm Dr. Kirsten Bibbins-Domingo, editor-in-chief of JAMA and the JAMA Network. I'm joined today by Dr. Esa Davis. She's a professor of family and community medicine, the associate vice president for community health at the University of Maryland, Baltimore, and the senior associate dean of population and community medicine at the University of Maryland School of Medicine. Dr. Davis is also the director of the transforming biomedical research and academic faculty through leadership, opportunities, training, and mentorship, or TRANSFORM. Dr. Davis is also a member of the US Preventive Services Task Force, and she's joining me here today to discuss the new recommendation statement from the US Preventive Services Task Force on screening for osteoporosis. JAMA has published this recommendation statement and the evidence report on which the recommendation is based. Dr. Davis, thank you for joining me here today. Oh, thank you for having me. Very good to see you. It's nice to see you again. So I usually like to start with just the high-level summary of this recommendation statement on screening for osteoporosis. What's the main message? The main message is that screening for osteoporosis can help prevent fractures in women that are 65 years and older and in younger women who have gone through menopause and are at increased risk. I see. So it sounds like clinicians in the primary care setting should be actively looking and trying to identify osteoporosis in all comers, women who are over the age of 65. And if you have risk factors and have gone through menopause under the age of 65, what's the way in which we're screening here? Yeah. So for those women who are over the age of 65, we are recommending screening for osteoporosis. And that can be done either with a bone mineral density exam alone or bone mineral density exam with the addition of screening for fracture risk with an assessment tool. I see. So this is like a DEXA scan? Correct. Or the DEXA scan plus another of the scoring risk assessment tools that exist? Correct. And that risk assessment tool assessing for risk of fracture. And that just gives further information on that woman's bone health. For women under 65, it's really kind of a two-step approach. So, it's first women who are under 65 who have gone through menopause, and then have clinical risk assessment that shows that they have other risk factors, such as either smoking or low body weight, and then having a risk assessment for either osteoporosis or risk assessment for increased fracture risk. And then with that information, determining who then needs to go on for screening with a bone density exam. I see. Okay. Give me an idea of what the scope of the problem is. How common is osteoporosis? Are we screening for it now? Where are the gaps? So, we are screening for osteoporosis. Osteoporosis is a disease in which the bones are weakened and thin. It is more common in women and older women over 65, very common in women under 65, again, who have gone through menopause and are at increased risk. It also affects men as well. We don't want to forget about that group. We are currently screening women over 65, and we currently are screening younger women who have menopause. So, the Task Force has a B recommendation, which means that the evidence is there. And, the benefits outweigh the risk of screening when it comes to women 65 and older, and those under 65 who have a higher risk. But, for men, even though osteoporosis does affect men, the Task Force assessment is that there is not sufficient evidence for which to make a recommendation. Tell me a little bit about that gap. Yeah, that's correct. So, we don't want to forget about men, because men do get affected with osteoporosis. And while it's more common in women, the morbidity and mortality is higher in men. The challenge here is that we're actually calling for more research when it comes to men, because there wasn't enough evidence to evaluate the benefits and harms of screening and treatment for osteoporosis in men. And so, there's a real need for more research so that we can understand, you know, what are the benefits of treatment. I mean, men are being screened, but the evidence for treatment and improved outcome, that evidence wasn't there. And so, really need more research with regards to men, because it is important, it does affect them, and, you know, we just need to learn more. So for women, age is important because it's related to menopause and other factors in the aging process. For men, who are the men we should be thinking about at risk? Right. So there are similar risk factors for men as for women. So that advancing age, if you have a history of smoking, or excess alcohol, low body weight, a parent that has had a hip fracture, or a man who has had a history of cortical steroid use, all put men at risk. So the risk factors are similar. And, you know, certainly if a man has any of those risk factors or is concerned about osteoporosis, we do recommend that he have a conversation with his clinician to determine screening and treatment for them. Wonderful. There are other gaps that the task force has highlighted in this report. Even though there is sufficient evidence to make the recommendation for screening in women, there are gaps and there are other areas where more research is needed. Perhaps, you could comment on that, particularly the limitations in the screening tools in certain populations. Yeah, absolutely. Certainly, there's more evidence needed for the risk assessment tools, particularly as it relates to different populations by race and ethnicity. Commonly used is FRACS for risk assessment for fractures. And while there is race-based calculations for FRACS, there's some limitations for FRACS based off of it being determined by an older cohort. Also, it's unclear in terms of patients of mixed race, how well they'll perform. So, there's some limitations with regards to using FRACS in different populations. And mostly because FRACS is determined based off of the incidence of fracture in those populations. So, definitely need more information on those risk assessment tools and how they perform across a lot of different populations. Interesting. Very good. So, you're a family physician, and give me a sense of how you see this in your practice in terms of either osteoporosis or the consequences of osteoporosis. Yeah. So, it's really important, you know, osteoporosis is one of those things that we need to make women aware of, especially those over 65. Hip fractures can be very devastating, or, you know, any of the major fractures related to thinning of the bones is very devastating and leads to a lot of disability. And so, it's really important to ensure that we're doing all that we can to screen for those who are most at risk for those fractures. I think particularly in the younger group, it's really helpful to be able to have a way to identify who's most at risk in that younger group, that under 65 who have gone through menopause and may have additional risk factors. It's really helpful to give guidance about what to do in that group and letting them also know to be aware of what may put them at increased risk. So, I think it's really important conversations to have and, you know, the guidance here is really helpful in that way. So, it is screening because we now have effective medications. We've had for many years effective medications that change the trajectory. And as you say, fractures in middle age and older age can really be devastating to one's quality of life, morbidity, and then ultimately mortality as well. And so, that sounds like it's the reason for the strong statement here on osteoporosis based on the evidence that the task force has reviewed. Absolutely. Wonderful. So again, why don't you give us the final take home message from the task force? Yes. So I think again, it's to remind everyone that osteoporosis continues to be a pretty devastating disease with increased morbidity and mortality. However, as you said, we have very effective treatments for it and that it's important that we screen for osteoporosis to help prevent these fractures, particularly in women over the age of 65 and in younger women who have gone through menopause and are at increased risk and that also we should not forget about men. Osteoporosis occurs in men as well and it's very, very important that we continue to call for more research so we can learn more about the effective ways to screen and treat in that particular population. And in the meantime, they should continue to have conversations with their clinicians about what's their best course of action for them. Wonderful. Great summary. Thank you so much for joining me here today. I've been speaking with Dr. Esa Davis, a family physician and a member of the US Preventive Services Task Force about the new task force recommendation on screening for osteoporosis. This episode was produced by Daniel Morrow at the JAMA Network. To follow this and other JAMA Network podcasts, please visit us online at jamanetworkaudio.com. Thanks for listening. This content is protected by copyright by the American Medical Association with all rights reserved, including those for text and data mining, AI training, and similar technologies.