National Task Force Recommends Osteoporosis Screening for Women 65 and Older

The U.S. Preventive Services Task Force (USPSTF) issued an updated recommendation in January advising that all women 65 and older should be screened for osteoporosis. The recommendation also includes revised guidance for postmenopausal women under 65 with certain risk factors.

Osteoporosis is a condition characterized by weakened bones that can increase the likelihood of fractures, particularly in older adults. Osteoporotic fractures are associated with serious complications which may include psychological distress, reduced ability to perform activities of daily living, and even death. Women are at higher risk than men due to bone density loss after menopause.

Updated Recommendations

The USPSTF’s recommendation of universal osteoporosis screening for women 65 and older is consistent with its 2018 recommendation on the topic. The task force also found there is insufficient evidence to assess whether osteoporosis screening for men deserves a recommendation, also consistent with its previous recommendation. However, there are some key differences in the updated recommendation. The 2018 recommendation called for postmenopausal women under 65 to be screened if they were determined through use of a formal clinical risk assessment tool to be at higher risk for osteoporosis; the new recommendation refines this approach by calling for women in this category to be screened if they are determined via clinical risk assessment to be at higher risk for osteoporotic fracture, prioritizing fracture risk over bone density alone.

In addition, whereas the 2018 recommendation characterized screening tests broadly as “bone measurement testing,” the updated recommendation provides more detail, specifying that screening tests can include “dual-energy x-ray absorptiometry” — an imaging test that uses x-rays to measure bone density — of the hip or lumbar spine, with or without fracture risk assessment.

Benefit to Patients

The USPSTF assigned a “B” grade to osteoporosis screening for women 65 and older, as well as for postmenopausal women under 65 who are identified as being at increased risk of osteoporotic fracture. This designation indicates “moderate certainty” that screening has a moderate to substantial net benefit.

The USPSTF is an independent, voluntary panel of national health experts in disease prevention and evidence-based medicine. Recommendations from the USPSTF are based on reviews of high-quality scientific evidence and are intended not only to offer guidance to healthcare providers but also to provide patients and their families with accurate and up-to-date information.

Coverage for Screenings

Under the Affordable Care Act (ACA), preventive services that receive a grade of “A” or “B” from the USPSTF must be covered by certain health plans without cost sharing. Examples of services with these grades include preventive measures such as mammograms to screen for breast cancer, colonoscopies to screen for colorectal cancer, and blood pressure screenings to detect cardiovascular disease. The task force’s recommendations play a key role in promoting early detection and prevention of serious health conditions.

There is ongoing litigation challenging the USPSTF’s authority, however. This spring, the U.S. Supreme Court will hear arguments in Becerra v. Braidwood Management Inc., a case challenging the constitutionality of the ACA’s preventive services coverage mandate. Plaintiffs in the case argue that because the mandate incorporates recommendations from the USPSTF, that means the task force’s members are acting as principal officers of the state. Under the Appointments Clause of the Constitution, principals of the state must be appointed by the president and confirmed by the Senate, which the USPSTF’s members have not been, the plaintiffs argue.

The 5^th Circuit Court of Appeals ruled in June that requiring health plans to cover services recommended by the USPSTF is unconstitutional, although it limited the ruling to apply only to the plaintiffs. The Supreme Court’s decision in the case could have implications for the future of preventive care coverage under the ACA.