Osteoporosis screening recommendation: was there a delay and, if so, why?

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Last week, the U.S. Preventive Services Task Force (USPSTF) announced that it “now recommends screening for osteoporosis in women ages 65 years and older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors. The recommendation appeared in the January 18 online issue of the Annals of Internal Medicine and is also available on the USPSTF Web site.

But Dr. Kenny Lin, who resigned from the support team of the USPSTF and resigned from the Agency for Healthcare Research and Quality last November, blogged that this was another example of “politics trumped science.” He wrote:

The problem, in my view, is that all of these facts were known more than two years ago, in November 2008, when a previous incarnation of the USPSTF (of which about half of the members remain on the panel) actually voted for these new recommendations. At that time, a typical interval between a Task Force vote to recommendation release was 9 to 12 months, and even that length of time was considered by many USPSTF members to be unacceptable, given the critical public health implications of many of these statements. (In a congressional hearing held in December 2009, USPSTF Chair Ned Calonge acknowledged that the 16-month interval between the vote and publication of the breast cancer screening recommendations was “much too long.”)

After the mammography debacle, though, the output of the USPSTF ground to a halt. After releasing an average of one new or updated recommendation each month for the previous 3 years, the Task Force published no new recommendations for nearly a year. All in-progress statements, including several (such as screening for osteoporosis) that were in press as of December 2009, were ordered to be withdrawn by a White House and DHHS leadership that would tolerate no further potential threats to the passage of health reform legislation. And even after the Affordable Care Act became law in March 2010, no remotely controversial statements were permitted to be introduced into the USPSTF’s new public comment process until after the November 2010 midterm elections.

…if we achieve “health reform” that grants insurance cards to 32 million more people, but doesn’t provide them with reliable access to primary care; selectively muzzles experts whom primary care physicians trust to tell them what works and what doesn’t in clinical prevention; and willfully allows outdated recommendations to guide coverage of primary care screening to prevent many of 1.5 million life-altering osteoporotic fractures that occur in the U.S. each year, then, well, we have achieved very little at all.

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