This story attempts to explore conflicting views about whether men should be screened for osteoporosis using bone scanning machines. But it didn’t do a very thorough job of evaluating the evidence or quantifying the benefits and harms of different approaches. Although readers may come away understanding the broad contours of the controversy, the story is too superficial to get at the core issues that underlie the disagreement.
All screening tests carry some risk for harm, and so any screening story that fails to mention those harms, as this story did, is inherently unbalanced. In addition, the story never even mentioned some of the many questions about overdiagnosis and overtreatment of osteopenia in women, and then dove headfirst into diagnosis and treatment of men without this important backdrop.
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.
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.
The story included no specific discussion of potential harms of bone scanning in men. These include:
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.
The statistics for osteoporosis prevalence cited in the story are consistent with estimates on the NIH website, and there was no exaggeration of the condition’s effects. Consumers should be cautioned, though, that one man’s thin bones may not equal another man’s thin bones – and that the estimates of one in five men with a "problem" may be an overstatement of how problematic it really is for all 20% reflected in this broad spectrum.
The story quotes two experts from the NOF and a bone health expert at Oregon Health & Science University.
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.
The availability of bone scans for men isn’t really in question, so we’ll call this one not applicable.
Whether men should be screened for osteoporosis is not a novel question, and the story doesn’t suggest that it is.
Since the story includes three expert interviews, we can be sure that it didn’t rely solely on a press release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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