US task force reaffirms bone-density screening for women 65 and older
The 2025 USPSTF statement keeps a B recommendation for women 65+ and for higher-risk younger postmenopausal women. The fracture benefit is real but small, and evidence gaps remain.
| Group | Value (value) |
|---|---|
| Hip fracture | 0.83 (0.73 to 0.93) |
| Major osteoporotic fracture | 0.94 (0.88 to 0.99) |
The US Preventive Services Task Force, in a statement published on 14 January 2025, again recommends bone-density screening to prevent fractures for all women aged 65 and older, and for postmenopausal women younger than 65 who are at increased risk — both "B" recommendations [s1]. For men, it again found the evidence insufficient to judge whether screening helps [s1]. The underlying benefit is real but modest: in the trials the task force reviewed, screening higher-risk older women averted roughly 5 to 6 fractures per 1,000 women screened [s2].
A "B" grade means the task force judges there is moderate net benefit and recommends the service; in US practice it also generally means the screening is covered without cost-sharing. The 2025 statement covers adults 40 or older who have no known osteoporosis and no history of a fragility fracture [s1] — that is, it is about finding disease before the first broken bone, not managing people already diagnosed.
What the evidence actually shows
The task force's companion evidence review is more revealing than the grade. Across three randomised trials enrolling 42,009 participants, screening was associated with a lower risk of hip fracture — a pooled relative risk of 0.83 (95% CI, 0.73 to 0.93) — and of major osteoporotic fracture, relative risk 0.94 (95% CI, 0.88 to 0.99), compared with usual care [s2]. In absolute terms that worked out to 5 to 6 fewer fractures per 1,000 women screened [s2].
Those trials did not screen with a bone-density scan alone. Two used a two-stage approach: estimate fracture risk with a tool such as FRAX, then order bone-mineral-density testing only if the estimate crossed a threshold [s2]. And the risk tools are imperfect predictors — most had an area under the curve between 0.60 and 0.80 for predicting major osteoporotic or hip fracture, which is poor-to-modest discrimination, and data on how well-calibrated they are were limited [s2]. Discrimination of that order means a tool separates those who will and will not fracture only modestly better than a coin at the hard end of the range — enough to be useful for triage, not enough to treat a risk estimate as a verdict.
The benefit of screening depends on treatment working once disease is found, and here the evidence is firmer. Against placebo, bisphosphonates reduced hip fractures (pooled relative risk 0.67; 95% CI, 0.45 to 1.00; 6 trials, 12,055 participants) and denosumab did as well (relative risk 0.60; 95% CI, 0.37 to 0.97 in the largest trial, 7,808 participants), with no meaningful increase in adverse events over several years [s2].
The gaps the task force names
Two absences in the evidence are worth foregrounding. The review found no trials that evaluated screening with bone-density testing alone, and none that evaluated screening in men or in younger women [s2]. That is the direct reason the recommendation for men is an "I" statement — insufficient evidence — rather than a yes or a no [s1]. It is a statement about missing trials, not a verdict that screening men is useless.
The review also does not resolve two practical questions clinicians face daily: which risk-assessment tool to use, and how often to rescreen. The instruments' modest discrimination [s2] means that who gets flagged as "increased risk" — and therefore who among under-65 postmenopausal women is screened at all — depends on choices the recommendation leaves open.
What it means for readers
For women 65 and older, the guidance is a reaffirmation, not a change: screening is recommended, and the expected benefit is a small but real reduction in fractures, concentrated in hips [s1][s2]. For younger postmenopausal women, whether screening is recommended turns on an individual risk estimate. The evidence base sits almost entirely in women, which is why the recommendation is strongest there and silent on men.
For the treatment side of this picture, see our coverage of a trial testing a shorter course of the bone-builder romosozumab, and of what the evidence says about dairy, calcium and fracture risk.
What to watch
Whether trials are mounted to fill the two gaps the task force named — screening in men, and screening by bone density alone — and whether better-calibrated risk tools narrow the uncertainty about which younger postmenopausal women benefit.
This article describes a screening recommendation and its evidence base. It is not medical advice, and screening decisions belong with a clinician who knows the individual case.
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