What does the USPSTF recommend regarding osteoporosis screening in postmenopausal women younger than 65 who are at increased risk?

• A. The USPSTF recommends against screening in all women under 65.
• B. The USPSTF recommends screening only those with prior fracture history.
• C. The USPSTF recommends screening for osteoporosis in postmenopausal women younger than 65 who are at increased risk for fracture.
• D. The USPSTF recommends screening every 3 years in all women under 65.

Answer: (C)

Screening should be guided by fracture risk, not age alone. For postmenopausal women under 65 who have increased fracture risk—due to factors like a prior fragility fracture, glucocorticoid use, low body weight, smoking, heavy alcohol use, or a positive family history—a bone density test (DXA) is recommended to assess for osteoporosis or osteopenia. Detecting low bone density early allows targeted interventions, such as medications, calcium and vitamin D optimization, and lifestyle changes, to reduce future fracture risk. The other options don’t fit this risk-based approach: screening all under 65 isn’t recommended, limiting screening only to those with a prior fracture misses other high-risk individuals, and there isn’t a blanket every-three-years schedule for all under-65 women.