A direct comparison of the recommendations presented in the above guidelines for screening and risk assessment for osteoporosis in postmenopausal women is provided in the tables below.

Areas of Agreement
Risk Assessment
All of the groups recommend an assessment for risk factors associated with osteoporosis and osteoporotic fracture. All adult patients ≥ age 50 (American College of Preventive Medicine [ACPM]); all postmenopausal women (The North American Menopause Society [NAMS]); all adults (University of Michigan Health System [UMHS]). The guidelines are in agreement that the key components of a risk assessment are assessing the individual for osteoporotic risk factors and subsequent BMD testing (if indicated) based on risk profile.

All three guidelines list common risk factors for osteoporosis that should be assessed for, including clinical risk factors (e.g., age, tobacco smoking, history of fragility fracture, low body weight, etc) as well as secondary risk factors (e.g., glucocorticoid therapy, rheumatoid arthritis, other secondary causes of osteoporosis).

In addition to assessment of risk factors, NAMS also recommends a physical examination that includes an annual measurement of height and weight, along with an assessment for chronic back pain and kyphosis. ACPM and NAMS both address the use of osteoporosis risk assessment tools, and recommend the WHO FRAX tool. ACPM recommends that clinicians consider using an osteoporosis risk–assessment tool that estimates absolute fracture risk (such as the FRAX), and compares different risk assessment tools available.
Indications for BMD Testing

The groups agree that the decision to test BMD should be based on the woman’s clinical risk factors/risk profile, as well as the potential impact of results on management. All three groups recommend BMD testing for all postmenopausal women aged 65 years or older, regardless of clinical risk factors. There is also agreement that BMD testing should be recommended for postmenopausal women younger than 65 (NAMS specifies women ≥50) when risk factors (identified during the risk assessment) are present.

Measurement of BMD: Modality and Frequency

The guidelines agree that DXA is the preferred technique for measurement of BMD. All of the groups acknowledge, however, that certain factors can interfere with the accuracy of DXA measurements. ACPM and UMHS cite vertebral compression fractures, osteoarthritis, osteophytes, and vascular calcification as factors that may spuriously elevate BMD measurement by DXA.

With regard to screening tools for osteoporosis other than DXA, ACPM and UMHS also address calcaneal QUS. While the groups agree that benefits compared to DXA include being portable, not exposing patients to radiation, and being less expensive, neither group recommends its use. According to ACPM, given the poor sensitivity of QUS for detecting osteoporosis, it has limited application in evidence-based screening programs. ACPM also addresses QCT, which they concluded has not yet been extensively researched, nor validated in relation to t-scores that predict fracture risk.

All three groups also address biochemical markers of bone formation and resorption. There is overall agreement that they do not predict BMD nor reliably estimate fracture risk and that their routine use in clinical practice is not recommended. The groups agree that they are most often used in research settings to monitor response to antiresorption therapy, owing to their potential to demonstrate changes in bone remodeling earlier (within several days to months) than BMD changes, which can require 1 to 3 years.

In terms of when to repeat BMD testing, there is overall agreement that an interval of at least two years is appropriate for most people. ACPM states that screening should not be performed more frequently than every 2 years. NAMS similarly notes that for untreated postmenopausal women, repeat DXA testing is not useful until 2 to 5 years have passed. For women receiving osteoporosis therapy, however, NAMS states that BMD monitoring may not provide clinically useful information until after 1 to 2 years of treatment.

UMHS provides repeat testing recommendations based on the t-score from the patient’s first DXA and their level of clinical risk, with repeat testing intervals ranging from 6 to 12 months (in the case of glucocorticoid use and/or transplantation) to 3 to 5 years. They state that for most persons an interval of ≥2 years provides the most meaningful information.
Areas of Difference
There are no significant areas of difference between the guidelines.

Read more at http://www.guideline.gov/syntheses/synthesis.aspx?id=25304