A Comparison of US and Canadian Osteoporosis Screening and Treatment Strategies in Postmenopausal Women

Carolyn J. Crandall, Joseph Larson, Jo Ann E. Manson, Jane A. Cauley, Andrea Z. LaCroix, Jean Wactawski-Wende, Mridul Datta, Maryam Sattari, John T. Schousboe, William D. Leslie, Kristine E. Ensrud

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16 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)607-615
Number of pages9
JournalJournal of Bone and Mineral Research
Issue number4
StatePublished - Apr 2019

Bibliographical note

Funding Information:
The WHI program is funded by the US Department of Health and Human Services, NIH, National Heart, Lung, and Blood Institute (NHLBI), through contracts HHSN268201600018C, HHSN26 8201600001C, HHSN268201600002C, HHSN268201600003C, and HHSN268201600004C. Program Office (NHLBI, Bethesda, MD, USA): Jacques Rossouw, Shari Ludlam, Joan McGowan, Leslie Ford, and Nancy Geller. Clinical Coordinating Center (Fred Hutchinson Cancer Research Center, Seattle, WA, USA): Garnet Anderson, Ross Prentice, Andrea LaCroix, and Charles Kooper-berg. Investigators and Academic Centers (Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA) JoAnn E. Manson; (MedStar Health Research Institute/Howard University, Washington, DC, USA) Barbara V. Howard; (Stanford Prevention Research Center, Stanford, CA, USA) Marcia L. Stefanick; (The Ohio State University, Columbus, OH, USA) Rebecca Jackson; (University of Arizona, Tucson/Phoenix, AZ, USA) Cynthia A. Thomson; (University at Buffalo, Buffalo, NY, USA) Jean Wactawski-Wende; (University of Florida, Gainesville/Jacksonville, FL, USA) Marian Limacher; (University of Iowa, Iowa City/ Davenport, IA, USA) Jennifer Robinson; (University of Pittsburgh, Pittsburgh, PA, USA) Lewis Kuller; (Wake Forest University School of Medicine, Winston-Salem, NC, USA) Sally Shumaker; (University of Nevada, Reno, NV, USA) Robert Brunner; (University of Minnesota, Minneapolis, MN, USA) Karen L. Margolis. We thank the participants of the Women’s Health Initiative Study for their time and effort.

Publisher Copyright:
© 2018 American Society for Bone and Mineral Research


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