are the harms associated with osteoporosis screening?’ Screening included BMD measurements and mainly involved DXA testing. Unfortunately, no studies were identified in this systematic review that evaluated the potential harms from screening. The lack of empirical evidence in this high-quality systematic review on safety confirmed that we had not missed any relevant studies in our literature searches. Is it effective? Direct evidence of diagnostic effectiveness Does BMD analysis using DXA for women in their 50th year improve health outcomes? Summary—For in their 50th year, what is the effectiveness of using DXA to diagnose low or low–normal BMD, compared with clinical assessment (including the use of existing fracture risk assessment tools but no DXA) of the risk of low BMD, in order to prevent minimal trauma fracture? No studies were that met all the inclusion criteria. A systematic review (Nelson et al. 2010) asking a similar research question identified no trials on the effectiveness of DXA screening. A further two studies that also had similar research questions were included and are described below due to the lack of evidence. In both these studies there was no information on the specified outcomes of fracture risk, quality of life or mortality/morbidity. The two studies measured change in BMD 1–2 years after a DXA test. Gutin et al. (1992) reported that the expected age-related reduction in BMD between visits was not found 12–18 months after DXA and subsequent lifestyle counselling in postmenopausal women. Winzenberg et al. (2006) reported a 1.1% increase per year (95%CI +0.9, +1.4) in femoral neck BMD from baseline to 2 years, and no change in lumbar spine BMD (+0.09% p.a.; 95%CI +0.20) in premenopausal women. They concluded that –0.06, DXA testing plus providing BMD results and lifestyle information is effective at increasing hip BMD during a 2-year follow-up. Studies would have been included to assess the effectiveness of DXA testing of women in their 50th year if they had met the criteria outlined a priori in Box 2. Box 2 Criteria for selecting studies to assess the effectiveness of BMD analyses using DXA on fracture risk, quality of life and morbidity/mortality in women in their 50th year Selection criteria Inclusion criteria
are the harms associated with osteoporosis screening?’ Screening included BMD measurements and mainly involved DXA testing. Unfortunately, no studies were identified in this systematic review that evaluated the potential harms from screening. The lack of empirical evidence in this high-quality systematic review on safety confirmed that we had not missed any relevant studies in our literature searches. Is it effective? Direct evidence of diagnostic effectiveness Does BMD analysis using DXA for women in their 50th year improve health outcomes? Summary—For in their 50th year, what is the effectiveness of using DXA to diagnose low or low–normal BMD, compared with clinical assessment (including the use of existing fracture risk assessment tools but no DXA) of the risk of low BMD, in order to prevent minimal trauma fracture? No studies were that met all the inclusion criteria. A systematic review (Nelson et al. 2010) asking a similar research question identified no trials on the effectiveness of DXA screening. A further two studies that also had similar research questions were included and are described below due to the lack of evidence. In both these studies there was no information on the specified outcomes of fracture risk, quality of life or mortality/morbidity. The two studies measured change in BMD 1–2 years after a DXA test. Gutin et al. (1992) reported that the expected age-related reduction in BMD between visits was not found 12–18 months after DXA and subsequent lifestyle counselling in postmenopausal women. Winzenberg et al. (2006) reported a 1.1% increase per year (95%CI +0.9, +1.4) in femoral neck BMD from baseline to 2 years, and no change in lumbar spine BMD (+0.09% p.a.; 95%CI –0.06, +0.20) in premenopausal women. They concluded that DXA testing plus providing BMD results and lifestyle information is effective at increasing hip BMD during a 2-year follow-up. Studies would have been included to assess the effectiveness of DXA testing of women in their 50th year if they had met the criteria outlined a priori in Box 2. Box 2 Criteria for selecting studies to assess the effectiveness of BMD analyses using DXA on fracture risk, quality of life and morbidity/mortality in women in their 50th year Selection criteria Inclusion criteria
1162_assessment_report.docx