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 |