Table 1 Key question 1 (benefits and harms of screening) study eligibility criteria
Criteria | Include | Exclude |
|---|---|---|
Population | Asymptomatic adults ≥ 40 years in the general population (we will include studies where ≥ 80% of the sample or the sample mean age − 1 standard deviation is ≥ 40 years) Subgroups for decision-making: age, sex, menopausal status Methods subgroups: diabetes, presence of prior fractures, baseline predicted fracture risk, length of follow-up |  ■Adults < 40 years  ■Treatment with anti-osteoporosis drugs at baseline  ■> 50% with prior diagnosis of osteoporosis, prior fragility fracture, endocrine or other disorders likely to be related to metabolic bone disease, chronic use of glucocorticoid medications, cancer |
Intervention | Screeninga to prevent fragility fracture with any of the following:  ■Fracture risk assessment alone (validated or non-validated tools; with or without BMD incorporated, if applicable to tool)  ■Bone mineral density (BMD) alone by dual-energy x-ray absorptiometry of the femoral neck and/or lumbar spine (DXA) ± vertebral fracture assessment (VFA)/spinal radiography  ■Fracture risk assessment followed by BMD (DXA) if indicated ± vertebral fracture assessment/spinal radiography Treatment of any form is offered for those participants reaching a threshold that is either investigator-defined or based on patient and/or clinician decision making. |  ■Other BMD or osteoporosis screening tests (e.g., quantitative ultrasound, quantitative computed tomography, peripheral DXA, trabecular bone score, bone turnover markers)  ■VFA without BMD |
Comparator | KQ1a: No screening KQ1b:  ■Another screening strategy (e.g., 1 vs. 2 step screening)  ■Screening using a different risk assessment tool |  ■Other BMD or osteoporosis-related screening tests  ■Fracture liaison services |
Outcomes | Benefits Critical  ■Hip fractures  ■Fracture-related mortality  ■Functionality and disability (includes surrogate measures such as frailty questionnaires and long-term care admissions)  ■Quality of life or well being  ■All clinical fragility fracturesb Important  ■All-cause mortality Harms Critical  ■Serious adverse eventsc (including all serious cardiovascular events; serious cardiac rhythm disturbances (e.g., atrial fibrillation or ventricular arrhythmia); serious gastrointestinal (GI) events (excluding cancers); GI cancer; atypical femoral fractures; osteonecrosis of the jaw) Important  ■Overdiagnosis  ■Discontinuations due to adverse events  ■Non-serious adverse events (including any adverse events or adverse (drug) reactions; any non-serious adverse events) |  |
Timing | Follow-up ≥ 6 months | Follow-up < 6 months |
Setting | Primary health care [117] | Long-term care facilities |
Study design and publication status |  ■Randomized controlled trials  ■Clinical controlled trials, only if neededd  ■Manuscripts, reports, abstracts, dissertations, and clinical trials registers, if data are available |  ■Systematic reviews, meta-analyses, and pooled analyses  ■All other primary study designs  ■Non-research (e.g., editorials)  ■Studies available only as conference proceedings or other grey literature, unless data are available and adequate to assess study design and risk of bias |
Language | English or French | All other languages |
Date of publication | Any | Not applicable |