Recommendations on screening for primary prevention of fragility fractures

Screening in primary care aims to decrease the risk of future fragility fractures among those without a prior fracture, and to reduce fracture-related morbidity, mortality, and costs. Potential harms have been also reported though, including overdiagnosis, adverse events of screening or treatment, and increased health care resource use.

The Canadian Task Force on Preventive Health Care has released guidelines that provide evidence-based recommendations on screening for primary prevention of fragility fractures. The target population is community-dwelling adults 40+ who are not on preventative pharmacotherapy for fragility fractures. The recommendations were based on an analysis of systematic reviews addressing benefits and harms of screening, predictive accuracy of risk assessment tools, patient acceptability and benefits of treatment.

In this guideline the “risk assessment-first” screening approach to prevent fragility fractures is recommended, which involves using a fracture risk estimation tool (e.g., FRAX without BMD), followed by shared decision making with the patient and BMD if the patient is interested in preventive treatment to lower their risk. If BMD measurement is requested, risk is then re-estimated by adding the BMD T-score to the calculation.

Shared decision-making was recommended in this framework, using an interactive decision aid which was developed to help patients consider the potential benefits and harms of preventive pharmacotherapy within their individual risk context.

Additionally, there is a strong recommendation against screening for females aged 40–64 years and males aged ≥ 40 years, as the risk of overdiagnosis and adverse events from potential medication outweighs the benefit of screening in these groups.

You can read the full paper here!