Your Health: Should men also be screened for osteoporosis?

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

If we’re in a position to say that bone scans are beneficial for men at high risk of osteoporosis, as the National Osteoporosis Foundation (NOF)suggests in this story, then we should also be prepared to talk about what these scans are going to cost. The story did not mention costs.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story gets credit for pointing out the lack of good evidence showing any benefit for screening in men, but we’re going to ding it for relying on an anecdote which throws the story out of balance. The story tells of a "fiftysomething laborer" who suffered from severe back pain and had undiagnosed osteoporosis. Although the suggestion is that this patient could have benefited from earlier screening, it is not at all clear how screening would have made a difference. As the story points out, we just don’t know if offering treatment to these types of men will help prevent them from sustaining a fracture.   Further, allowing the National Osteoporosis Foundation president to say that the data point in the direction of a benefit from prescribing drugs or other treatments to men with low scores without delving into that data is insufficient in our view.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story included no specific discussion of potential harms of bone scanning in men. These include:

• Exposure to potentially harmful radiation from the scan.
• Overtreatment of men who are identified as having osteoporosis when they do not (false positives). Adverse effects of drug treatments for osteoporosis may include gastrointestinal problems, musculoskeletal pain, and blood clots. 
• Anxiety and avoidance of health-promoting physical activity due to perceived vulnerability to a fracture.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

A major point of the story is that new draft recommendations from the U.S. Preventive Services Task Force (USPSTF) for osteoporosis screening differ from those issued by the National Osteoporosis Foundation (NOF). The USPSTF says there isn’t enough evidence to support screening for osteoporosis in men, but the NOF recommends screening for men at high risk for the condition. Leaving aside the issue of which men should be considered at "high risk" for osteoporosis (the story includes men "over 65 or 70" in this group, but a ballpark estimate isn’t good enough), what would be helpful here is some discussion of the evidence that supports the NOF’s more aggressive screening stance. While the story correctly notes that there is no evidence that screening high-risk men for osteoporosis will help prevent fractures, it cites an NOF spokesperson who suggests vaguely that the data "point in [the] direction" of benefit. Unfortunately, there is no further discussion of what data the NOF is talking about here. We think this issue is important enough to merit a more specific description of these supportive studies and their outcomes.  

Does the story compare the new approach with existing alternatives?

Not Satisfactory

As the USPSTF review of the evidence indicates, we can’t tell if screening men for osteoporosis will improve their health more than if they didn’t get screened. This suggests that men may reasonably choose not to get screened, but the story didn’t mention this option.