Acknowledgments

The authors thank Peggy Nygren, MA; Nancy Carney, P.H.D.; Kathryn Pyle Krages, AMLS, MA; Benjamin Chan, MS; and the reviewers of the full evidence report for their contributions to this project.

Support: This study was conducted by the Oregon Health & Science University Evidence-based Practice Center under Contract No. 290-97-0018, task order Nos. 2 and 4, to the Agency for Healthcare Research and Quality, Rockville, MD.

Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the U.S. Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

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References

1. Melton LJ, 3rd, Kan SH, Frye MA, Wahner HW, O'Fallon WM, Riggs BL. Epidemiology of vertebral fractures in women. Am J Epidemiol 1989;129(5):1000-11.

2. Barrett JA, Baron JA, Karagas MR, Beach ML. Fracture risk in the U.S. Medicare population. J Clin Epidemiol 1999;52(3):243-9.

3. White BL, Fisher WD, Laurin CA. Rate of mortality for elderly patients after fracture of hip in the 1980s. J Bone Joint Surg 1987;69A:1335-40.

4. Cauley J, Thompson D, Ensrud K, Scott J, Black D. Risk of mortality following clinical fractures. Osteoporos Intern 2000;11(7):556-61.

5. Melton LJ, 3rd. Epidemiology of spinal osteoporosis. Spine 1997;22(24 Suppl):2S-11S.

6. Consensus development conference: prophylaxis and treatment of osteoporosis. Am J Med 1991;90:107-10.

7. Consensus Development Conference. Diagnosis, prophylaxis and treatment of osteoporosis. Am J Med 1993;94:646-50.

8. Assessment of Fracture Risk and Its Application to Screening for Postmenopausal Osteoporosis. World Health Organization. WHO Technical Report Series 843. Geneva: World Health Organization; 1994.

9. Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int 1994;4(6):368-81.

10. Melton LJ, 3rd. How many women have osteoporosis now? J Bone Miner Res 1995;10(2):175-7.

11. Heaney RP. Bone mass, bone loss, and osteoporosis prophylaxis. [Editorial] Ann Intern Med 1998;128(4):313-4.

12. Bone density measurement-a systematic review. Swedish Council on Technology Assessment in Health Care. J Intern Med Suppl 1997; 739:1-60.

13. Hailey D, Sampietro-Colom L, Marshall D. INAHTA project on the effectiveness of bone density measurement and associated treatments for prevention of fractures. Statement of findings. Edmonton, Alberta, Canada: Alberta Heritage Foundation for Medical Research; 1996.

14. Green CJ, Bassett K, Foerster V. Bone mineral density testing: does the evidence support its selective use in well women? British Columbia, Canada: British Columbia Office of Health Technology Assessment; 1997. Report no. 97:2T.

15. Osteoporosis: review of the evidence for prevention, diagnosis, and treatment and cost-effectiveness analysis. National Osteoporosis Foundation. Osteoporos Int 1998; 8Suppl 4):S7-S88.

16. Homik J, Hailey D. Quantitative ultrasound for bone density measurement. Edmonton, Alberta, Canada: Alberta Heritage Foundation for Medical Research; 1998. Report No.: Health Technology Assessment 11.

17. Homik J, Hailey D. Selective testing with bone density measurement. Edmonton, Alberta, Canada: Alberta Heritage Foundation for Medical Research; 1999. Report No. Health Technology Brief 4.

18. Osteoporosis: Clinical guidelines for prevention and treatment. Royal College of Physicians. London: Royal College of Physicians of London; 1999.

19. Ultrasonography of the heel for diagnostic osteoporosis and selecting patients for pharmacologic treatment. Blue Cross Blue Shield Association. Chicago: Blue Cross and Blue Shield Assoc; 1999.

20. Siebzehner MI. Consensus statement on prevention and treatment of osteoporosis. Isr Med Assoc J 2000;2(5):397-401.

21. Guide to Clinical Preventive Services, 2nd ed. Report of the U.S. Preventive Services Task Force. U.S. Preventive Services Task Force. Baltimore: Williams & Wilkins; 1996.

22. Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, et al. Current methods of the U.S. Preventive Services Task Force: a review of the process. Am J Prev Med 2001;20(3S): 21-35.

23. Nelson H, Helfand M, Woolf S, Allan J. Screening for Postmenopausal Osteoporosis: Systematic Evidence Review. Rockville, MD: Agency for Healthcare Research and Quality; 2002.

24. Nelson H, Morris CD, Kraemer D, Mahon S, Carney N, Nygren P, et al. Osteoporosis in Postmenopausal Women: Diagnosis and Monitoring, Rockville, MD: Agency for Healthcare Research and Quality; 2002.

25. Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, et al. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 1995;332(12):767-73.

26. Honkanen R, Tuppurainen M, Kroger H, Alhava E, Saarikoski S. Relationships between risk factors and fractures differ by type of fracture: a population-based study of 12,192 perimenopausal women. Osteoporos Int 1998;8(1):25-31.

27. Meyer HE, Tverdal A, Falch JA. Risk factors for hip fracture in middle-aged Norwegian women and men. Am J Epidemiol 1993;137(11):1203-11.

28. Kreiger N, Kelsey JL, Holford TR, O'Connor T. An epidemiologic study of hip fracture in postmenopausal women. Am J Epidemiol 1982;116(1):141-8.

29. Fujiwara S, Kasagi F, Yamada M, Kodama K. Risk factors for hip fracture in a Japanese cohort. J Bone Miner Res 1997;12(7):998-1004.

30. Siris ES, Miller PD, Barrett-Conner E, Faulkner KG, Wehren LE, Abbott TA, et al. Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: Results from the National Osteoporosis Risk Assessment. JAMA 2001;286(22):2815-2822.

31. Torgerson DJ, Campbell MK, Thomas RE, Reid DM. Prediction of perimenopausal fractures by bone mineral density and other risk factors. J Bone Miner Res 1996;11(2):293-7.

32. Mallmin H, Ljunghall S, Persson I, Bergstrom R. Risk factors for fractures of the distal forearm: a population-based case-control study. Osteoporos Int 1994;4(6):298-304.

33. Tuppurainen M, Kroger H, Honkanen R, Puntila E, Huopio J, Saarikoski S, et al. Risks of perimenopausal fractures—a prospective population-based study. Acta Obstet Gynecol Scand 1995;74(8):624-8.

34. Slemenda CW, Hui SL, Longcope C, Wellman H, Johnston CC, Jr. Predictors of bone mass in perimenopausal women. A prospective study of clinical data using photon absorptiometry. Ann Intern Med 1990;112(2):96-101.

35. Falch JA, Sandvik L, Van Beresteijn EC. Development and evaluation of an index to predict early postmenopausal bone loss. Bone 1992;13(4):337-41.

36. Ribot C, Pouilles JM, Bonneu M, Tremollieres F. Assessment of the risk of post-menopausal osteoporosis using clinical factors. Clin Endocrinol (Oxf) 1992;36(3):225-8.

37. Elliot JR, Gilchrist NL, Wells JE, Ayling E, Turner J, Sainsbury R. Historical assessment of risk factors in screening for osteopenia in a normal Caucasian population. Aust N Z J Med 1993;23(5):458-62.

38. Michaelsson K, Bergstrom R, Mallmin H, Holmberg L, Wolk A, Ljunghall S. Screening for osteopenia and osteoporosis: selection by body composition. Osteoporos Int 1996;6(2):120-6.

39. Verhaar HJ, Koele JJ, Neijzen T, Dessens JA, Duursma SA. Are arm span measurements useful in the prediction of osteoporosis in postmenopausal women? Osteoporos Int 1998;8(2):174-6.

40. Ballard PA, Purdie DW, Langton CM, Steel SA, Mussurakis S. Prevalence of osteoporosis and related risk factors in UK women in the seventh decade: osteoporosis case finding by clinical referral criteria or predictive model? Osteoporos Int 1998;8(6):535-9.

41. Lydick E, Cook K, Turpin J, Melton M, Stine R, Byrnes C. Development and validation of a simple questionnaire to facilitate identification of women likely to have low bone density. Am J Manag Care 1998;4(1):37-48.

42. Goemaere S, Zegels B, Toye K, Cremer S, Demuynck R, Daems M, et al. Limited clinical utility of a self-evaluating risk assessment scale for postmenopausal osteoporosis: lack of predictive value of lifestyle-related factors. Calcif Tissue Int 1999;65:354-8.

43. Cadarette SM, Jaglal SB, Kreiger N, McIsaac WJ, Darlington GA, Tu JV. Development and validation of the Osteoporosis Risk Assessment Instrument to facilitate selection of women for bone densitometry. CMAJ 2000;162:1289-94.

44. Kleerekoper M, Peterson E, Nelson D, Tilley B, Phillips E, Schork MA, et al. Identification of women at risk for developing postmenopausal osteoporosis with vertebral fractures: role of history and single photon absorptiometry. Bone Miner 1989;7(2):171-86.

45. van Hemert AM, Vandenbroucke JP, Birkenhager JC, Valkenburg HA. Prediction of osteoporotic fractures in the general population by a fracture risk score. A 9-year followup among middle-aged women. Am J Epidemiol 1990;132(1):123-35.

46. Cooper C, Shah S, Hand DJ, Adams J, Compston J, Davie M, et al. Screening for vertebral osteoporosis using individual risk factors. Osteoporos Int 1991;2:48-53.

47. Wolinsky FD, Fitzgerald JF. The risk of hip fracture among noninstitutionalized older adults. J Gerontol 1994;49(4):S165-75.

48. Johnell O, Gullberg B, Kanis JA, Allander E, Elffors L, Dequeker J, et al. Risk factors for hip fracture in European women: the MEDOS Study. Mediterranean Osteoporosis Study. J Bone Miner Res 1995;10(11):1802-15.

49. Ranstam J, Elffors L, Kanis JA. A mental-functional risk score for prediction of hip fracture. Age Ageing 1996;25(6):439-42.

50. Tromp AM, Smit JH, Deeg DJ, Bouter LM, Lips P. Predictors for falls and fractures in the Longitudinal Aging Study Amsterdam. J Bone Miner Res 1998;13(12):1932-9.

51. Burger H, de Laet CE, Weel AE, Hofman A, Pols HA. Added value of bone mineral density in hip fracture risk scores. Bone 1999;25(3):369-74.

52. Cadarette S, Jaglal S, Murray T, Mclsac W, Joesph L, Brown J. Evaluation of decision rules for referring women for bone densitometry by dual-energy x-ray absorptiometry. JAMA 2001;286(1):57-63.

53. Physician's Guide to Prevention and Treatment of Osteoporosis. National Osteoporosis Foundation. Washington, D.C.: Excerpta Medica, Inc.; 1999.

54. Weinstein L, Ullery B. Identification of at-risk women for osteoporosis screening. Am J Obstet Gynecol 2000;183:547-549.

55. Blake GM, Gluer CC, Fogelman I. Bone densitometry: current status and future prospects. Br J Radiol 1997;70 Spec No:S177-86.

56. Blake GM, Fogelman I. Applications of bone densitometry for osteoporosis. Endocrinol Metab Clin North Am 1998;27(2):267-88.

57. Genant HK, Engelke K, Fuerst T, Gluer CC, Grampp S, Harris ST, et al. Noninvasive assessment of bone mineral and structure: state of the art. J Bone Miner Res 1996;11(6):707-30.

58. Jergas M, Genant HK. Spinal and femoral DXA for the assessment of spinal osteoporosis. Calcif Tissue Int 1997;61(5):351-7.

59. Agren M, Karellas A, Leahey D, Marks S, Baran D. Ultrasound attenuation of the calcaneus: a sensitive and specific discriminator of osteopenia in postmenopausal women. Calcif Tissue Int 1991;48(4):240-4.

60. Alenfeld FE, Wuster C, Funck C, Pereira-Lima JF, Fritz T, Meeder PJ, et al. Ultrasound measurements at the proximal phalanges in healthy women and patients with hip fractures. Osteoporos Int 1998;8(5):393-8.

61. Cunningham JL, Fordham JN, Hewitt TA, Speed CA. Ultrasound velocity and attenuation at different skeletal sites compared with bone mineral density measured using dual energy X-ray absorptiometry. Br J Radiol 1996;69(817):25-32.

62. Faulkner KG, McClung MR, Coleman LJ, Kingston-Sandahl E. Quantitative ultrasound of the heel: correlation with densitometric measurements at different skeletal sites. Osteoporos Int 1994;4:42-7.

63. Formica CA, Nieves JW, Cosman F, Garrett P, Lindsay R. Comparative assessment of bone mineral measurements using dual X-ray absorptiometry and peripheral quantitative computed tomography. Osteoporos Int 1998;8(5):460-7.

64. Graafmans WC, Van Lingen A, Ooms ME, Bezemer PD, Lips P. Ultrasound measurements in the calcaneus: precision and its relation with bone mineral density of the heel, hip, and lumbar spine. Bone 1996;19(2):97-100.

65. Grampp S, Jergas M, Lang P, Steiner E, Fuerst T, Gluer CC, et al. Quantitative CT assessment of the lumbar spine and radius in patients with osteoporosis. Am J Roentgenol 1996;167(1):133-40.

66. Greenspan SL, Bouxsein ML, Melton ME, Kolodny AH, Clair JH, Delucca PT, et al. Precision and discriminatory ability of calcaneal bone assessment technologies. J Bone Miner Res 1997;12(8):1303-13.

67. Langton CM, Ballard PA, Bennett DK, Purdie DW. A comparison of the sensitivity and specificity of calcaneal ultrasound measurements with clinical criteria for bone densitometry (DEXA) referral. Clin Rheumatol 1997;16(1):117-8.

68. Laval-Jeantet AM, Bergot C, Williams M, Davidson K, Laval-Jeantet M. Dual-energy X-ray absorptiometry of the calcaneus: comparison with vertebral dual-energy X-ray absorptiometry and quantitative computed tomography. Calcif Tissue Int 1995;56(1):14-8.

69. Martin JC, Reid DM. Appendicular measurements in screening women for low axial bone mineral density. Br J Radiol 1996;69(819):234-40.

70. Massie A, Reid DM, Porter RW. Screening for osteoporosis: comparison between dual energy X-ray absorptiometry and broadband ultrasound attenuation in 1000 perimenopausal women. Osteoporos Int 1993;3(2):107-10.

71. Naganathan V, March L, Hunter D, Pocock NA, Markovey J, Sambrook PN. Quantitative heel ultrasound as a predictor for osteoporosis. Med J Aust 1999;171(6):297-300.

72. Pocock NA, Noakes KA, Howard GM, Nguyen TV, Kelly PJ, Sambrook PN, et al. Screening for osteoporosis: what is the role of heel ultrasound? Med J Aust 1996;164:367-70.

73. Rosenthall L, Tenenhouse A, Caminis J. A correlative study of ultrasound calcaneal and dual-energy X-ray absorptiometry bone measurements of the lumbar spine and femur in 1000 women. Eur J Nucl Med 1995;22(5):402-6.

74. Roux C, Lemonnier E, Lolta S, Charpentier E, Dougados M, Amor B, et al. [Ultrasound attenuation in calcaneus and bone density.] Rev Rhum Engl Ed Fr 1993;60:897-906.

75. Salamone L, Krall E, Dawson-Hughes B. Comparison of broadband ultrasound attenuation to single X-ray absorptiometry measurements at the calcaneus in postmenopausal women. Calcif Tissue Int 1994;54:87-90.

76. Schott AM, Weill-Engerer S, Hans D, Duboeuf F, Delmas PD, Meunier PJ. Ultrasound discriminates patients with hip fracture equally well as dual energy X-ray absorptiometry and independently of bone mineral density. J Bone Miner Res 1995;10(2):243-9.

77. Tromp AM, Smit JH, Deeg DJ, Lips P. Quantitative ultrasound measurements of the tibia and calcaneus in comparison with DXA measurements at various skeletal sites. Osteoporos Int 1999;9(3):230-5.

78. Turner CH, Peacock M, Timmerman L, Neal JM, Johnston CC Jr. Calcaneal ultrasonic measurements discriminate hip fracture independently of bone mass. Osteoporos Int 1995;5:130-5.

79. Young H, Howey S, Purdie DW. Broadband ultrasound attenuation compared with dual-energy X-ray absorptiometry in screening for postmenopausal low bone density. Osteoporos Int 1993;3(3):160-4.

80. Ahmed AI, Blake GM, Rymer JM, Fogelman I. Screening for osteopenia and osteoporosis: do the accepted normal ranges lead to overdiagnosis? Osteoporos Int 1997;7:432-38.

81. Petley GW, Cotton AM, Murrills AJ, Taylor PA, Cooper C, Cawley MI, et al. Reference ranges of bone mineral density for women in southern England: the impact of local data on the diagnosis of osteoporosis. Br J Radiol 1996;69(823):655-60.

82. Chen Z, Maricic M, Lund P, Tesser J, Gluck O. How the new Hologic hip normal reference values affect the densitometric diagnosis of osteoporosis. Osteoporos Int 1998;8:423-27.

83. Simmons A, Barrington S, O'Doherty MJ, Coakley AJ. Dual energy X-ray absorptiometry normal reference range use within the UK and the effect of different normal ranges on the assessment of bone density. Br J Radiol 1995;68(812):903-9.

84. Lunt M, Felsenberg D, Reeve J, Benevolenskaya L, Cannata J, Dequeker J, et al. Bone density variation and its effects on risk of vertebral deformity in men and women studied in thirteen European centers: the EVOS Study. J Bone Miner Res 1997;12(11):1883-94.

85. Laskey M, Crisp A, Cole T, Compston J. Comparison of the effect of different reference data on Lunar DPX and Hologic QDR-1000 dual-energy X-ray absorptiometers. Br J Radiol 1992;65(780):1124-29.

86. Arlot ME, Sornay-Rendu E, Garnero P, Vey-Marty B, Delmas PD. Apparent pre- and postmenopausal bone loss evaluated by DXA at different skeletal sites in women: the OFELY cohort. J Bone Miner Res 1997;12(4):683-90.

87. Faulkner KG, von Stetten E, Miller P. Discordance in patient classification using T-scores. J Clin Densitomet 1999;2(3):343-50.

88. Grampp S, Henk CB, Fuerst TP, Lu Y, Bader TR, Kainberger F, et al. Diagnostic agreement of quantitative sonography of the calcaneus with dual X-ray absorptiometry of the spine and femur. Am J Roentgenol 1999;173(2):329-34.

89. Kroger H, Lunt M, Reeve J, Dequeker J, Adams JE, Birkenhager JC, et al. Bone density reduction in various measurement sites in men and women with osteoporotic fractures of spine and hip: the European quantitation of osteoporosis study. Calcif Tissue Int 1999;64(3):191-9.

90. Varney LF, Parker RA, Vincelette A, Greenspan SL. Classification of osteoporosis and osteopenia in postmenopausal women is dependent on site-specific analysis. J Clin Densitomet 1999;2(3):275-83.

91. Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 1996;312:1254-59.

92. Cummings SR, Black DM, Nevitt MC, Browner W, Cauley J, Ensrud K, et al. Bone density at various sites for prediction of hip fractures. Lancet 1993;341:72-5.

93. Melton LJ, Atkinson E, O'Fallon W, Wahner H, Riggs B. Long-term fracture prediction by bone mineral assessed at different skeletal sites. J Bone Miner Res 1993;8(10):1227-33.

94. Black DM, Cummings SR, Genant HK, Nevitt MC, Palermo L, Browner W. Axial and appendicular bone density predict fractures in older women. J Bone Miner Res 1992;7(6):633-38.

95. Bauer DC, Gluer CC, Cauley JA, Vogt TM, Ensrud KE, Genant HK, et al. Broadband ultrasound attenuation predicts fractures strongly and independently of densitometry in older women. A prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med 1997;157(6):629-34.

96. Nevitt MC, Johnell O, Black DM, Ensrud K, Genant HK, Cummings SR. Bone mineral density predicts non-spine fractures in very elderly women. Study of Osteoporotic Fractures Research Group. Osteoporos Int 1994;4(6):325-31.

97. Duboeuf F, Hans D, Schott AM, Kotzki PO, Favier F, Marcelli C, et al. Different morphometric and densitometric parameters predict cervical and trochanteric hip fracture: the EPIDOS Study. J Bone Miner Res 1997;12(11):1895-902.

98. Garnero P, Dargent-Molina P, Hans D, Schott AM, Breart G, Meunier PJ, et al. Do markers of bone resorption add to bone mineral density and ultrasonographic heel measurement for the prediction of hip fracture in elderly women? The EPIDOS prospective study. Osteoporos Int 1998;8(6):563-9.

99. Hans D, Dargent-Molina P, Schott AM, Sebert JL, Cormier C, Kotzki PO, et al. Ultrasonographic heel measurements to predict hip fracture in elderly women: the EPIDOS prospective study. Lancet 1996;348(9026):511-4.

100. Schott AM, Cormier C, Hans D, Favier F, Hausherr E, Dargent-Molina P, et al. How hip and whole-body bone mineral density predict hip fracture in elderly women: the EPIDOS Prospective Study. Osteoporos Int 1998;8(3):247-54.

101. Nelson H. Hormone Replacement Therapy and Osteoporosis: Systematic Evidence Review. Rockville, MD: Agency for Healthcare Research and Quality; 2002.

102. Cranney A, Wells G, Willan A, Griffith L, Zytaruk N, Robinson V, et al. Meta-analysis of alendronate for the treatment of postmenopausal women. Endocr Rev 2002; 23: 517-23.

103. Adami S, Passeri M, Ortolani S, Broggini M, Carratelli L, Caruso I, et al. Effects of oral alendronate and intranasal salmon calcitonin on bone mass and biochemical markers of bone turnover in postmenopausal women with osteoporosis. Bone 1995:383-90.

104. Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 1996:1535-41.

105. Bone HG, Downs RW, Jr., Tucci JR, Harris ST, Weinstein RS, Licata AA, et al. Dose-response relationships for alendronate treatment in osteoporotic elderly women. Alendronate Elderly Osteoporosis Study Centers. J of Clin Endocrin & Met 1997:265-74.

106. Chesnut CH 3rd, McClung MR, Ensrud KE, Bell NH, Genant HK, Harris ST, et al. Alendronate treatment of the postmenopausal osteoporotic woman: effect of multiple dosages on bone mass and bone remodeling. Am J Med 1995:144-52.

107. Cummings SR, Black DM, Thompson DE, Applegate WB, Barrett-Connor E, Musliner TA, et al. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 1998:2077-82.

108. Greenspan SL, Parker RA, Ferguson L, Rosen HN, Maitland-Ramsey L, Karpf DB. Early changes in biochemical markers of bone turnover predict the long-term response to alendronate therapy in representative elderly women: A randomized clinical trial. J Bone Miner Res 1998;13:1431-8.

109. Hosking D, Chilvers CE, Christiansen C, Ravn P, Wasnich R, Ross P, et al. Prevention of bone loss with alendronate in postmenopausal women under 60 years of age. Early Postmenopausal Intervention Cohort Study Group. N Engl J Med 1998:485-92.

110. Liberman UA, Weiss SR, Broll J, Minne HW, Quan H, Bell NH, et al. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. The Alendronate Phase III Osteoporosis Treatment Study Group. N Engl J Med 1995:1437-43.

111. McClung M, Clemmesen B, Daifotis A, Gilchrist NL, Eisman J, Weinstein RS, et al. Alendronate prevents postmenopausal bone loss in women without osteoporosis. A double-blind, randomized, controlled trial. Alendronate Osteoporosis Prevention Study Group. Ann Intern Med 1998:253-61.

112. Pols HA, Felsenberg D, Hanley DA, Stepan J, Munoz-Torres M, Wilkin TJ, et al. Multinational, placebo-controlled, randomized trial of the effects of alendronate on bone density and fracture risk in postmenopausal women with low bone mass: results of the FOSIT study. Foxamax International Trial Study Group. Osteoporo Intern 1999:461-8.

113. Bonnick S, Rosen C, Mako B, DeLucca P, Byrnes C, Melton M. Alendronate vs calcium for treatment of osteoporosis in postmenopausal women. Bone 1998:23(5S):S476.

114. Cummings SR, Black DM, Thompson DE. Effect of alendronate reduces on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 1998;280(24):2077-82.

115. McClung M, Geusens P, Miller P, Zippel H, Bensen W, Roux C, et al. Effect of risedronate on the risk of hip fracture in elderly women. N Engl J Med 2001;344(5):333-40.

116. Johansen HK, Gotzsche PC. Problems in the design and reporting of trials of antifungal agents encountered during meta-analysis. JAMA 1999;282(18):1752-9.

117. Djulbegovic B, Lacevic M, Cantor A, Bennett C, Adams J, Kuderer N, et al. The uncertainty principle and industry-sponsored research. Lancet 2000;356(356):635-38.

118. Rimes KA, Salkovskis PM, Shipman AJ. Psychological and behavioural effects of bone density screening for osteoporosis. Psychol Health 1999;14:585-608.

119. Lyles KW, Gold DT, Shipp KM, Pieper CF, Martinez S, Mulhausen PL. Association of osteoporotic vertebral compression fractures with impaired functional status. Am J Med 1993;94:595-601.

120. Stock JL, Waud CE, Coderre JA, Overdorf JH, Janikas JS, Heiniluoma KM, et al. Clinical reporting to primary care physicians leads to increased use and understanding of bone densitometry and affects the management of osteoporosis: a randomized trial. Ann Intern Med 1998;128(12):996-9.

121. Ettinger B, Pressman A, Schein J. Clinic visits and hospital admissions for care of acid-related upper gastrointestinal disorders in women using alendronate for osteoporosis. Am J Manag Care 1998;4(10):1377-82.

122. National Physician Fee Schedule Payment Amount File. Baltimore, MD: Health Care Financing Administration; 2000.

123. Melton LJ 3rd, Chrischilles EA, Cooper C, Lane AW, Riggs BL. Perspective. How many women have osteoporosis? J Bone Miner Res 1992;7(9):1005-10.

124. Reginster J, Minne HW, Sorensen OH, Hooper M, Roux C, Brandi ML, et al. Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis: Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. Osteo Intern 2000;11(1):83-91.

125. Weinstein L, Ullery B, Bourguignon C. A simple system to determine who needs osteoporosis screening. Obstet Gyn 1999;93:757-60.

126. Health Technology Assessment. Number 6: Bone Densitometry: Patients with Asymptomatic Hyperparathyroidism. Agency for Health Care Policy and Research, U.S. Department of Health and Human Services. Rockville, MD: Agency for Health Care Policy and Research; 1995; AHRQ Publication No. 96-0004.

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Notes

Author Affiliations

[a] Dr. Nelson, Dr.Helfand: Evidence-based Practice Center and Division of Medical Informatics and Outcomes Research, Oregon Health & Science University, Portland, OR.
[b] Dr. Nelson, Dr.Helfand: Medical Service, Veterans Affairs Medical Center, Portland, OR.
[c] Dr. Woolf: Department of Family Practice, Virginia Commonwealth University, Fairfax, VA.
[d] Dr. Allan: School of Nursing, the University of Maryland, Baltimore, Baltimore, MD.

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Source: Nelson HD, Helfand M, Woolf SH, Allan JD. Screening for postmenopausal osteoporosis: A review of the evidence for the US Preventive Services Task Force. Ann Intern Med 2002;137:529-41.

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Internet Citation:

Nelson HD, Helfand M, Woolf SH, Allan JD. Screening for Postmenopausal Osteoporosis. Summary of the Evidence. Originally in Ann Intern Med 2002;137:529-41. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/3rduspstf/osteoporosis/osteosumm1.htm