This patient should be screened for osteoporosis with dual-energy x-ray absorptiometry (DEXA). The U.S. Preventive Services Task Force (USPSTF) recommends screening for osteoporosis by measurement of bone mineral density in women aged 65 years and older and in younger women who have a fracture risk equal to or higher than a 65-year-old white woman (9.3%). The Fracture Risk Assessment Tool (FRAX) (available at www.shef.ac.uk/FRAX/) can be used to determine if the 10-year fracture risk for younger women is greater than or equal to 9.3%. Risk factors that can increase the FRAX score include a first-degree relative with a history of hip fracture, alcohol abuse, smoking, low body mass, and glucocorticoid use. Although this patient is younger than 65 years, her parental history of hip fracture increases her risk of fracture to 13%; therefore, she should be screened for osteoporosis using DEXA.

In November 2016, the USPSTF published a new statement recommending statin therapy for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) in adults aged 40 to 75 years with a 10-year ASCVD event risk of 10% or higher and one or more ASCVD risk factors (dyslipidemia, diabetes, hypertension, or smoking) (Bibbins-Domingo K et al, 2016). Routine screening for lipid disorders and calculation of 10-year ASCVD risk using the Pooled Cohort Equations should be performed in this age group. The optimal interval for assessment of cardiovascular risk is undetermined; however, it is reasonable to measure lipid levels every 5 years in this population. Since this patient's lipid panel was normal when tested last year, screening in this patient would not be appropriate.

In an updated statement issued in December 2015, the USPSTF recommends screening for abnormal blood glucose as part of a cardiovascular risk assessment in adults aged 40 to 70 years who are overweight or obese (Siu AL et al, 2015). The evidence for the optimal screening frequency is limited, but the USPSTF suggests screening every 3 years. The American Diabetes Association recommends screening all adults for diabetes every 3 years beginning at age 45 years, regardless of weight. The American Diabetes Association also recommends screening asymptomatic adults of any age who are overweight or obese and who have one or more additional risk factors for diabetes. This patient was screened for diabetes last year, and therefore, she does not need to be screened again now.

A combination of cytology (Pap smear) and human papillomavirus (HPV) testing can be performed every 5 years in women aged 30 to 65 years to screen for cervical cancer. Screening with a Pap smear alone every 3 years is also acceptable. This patient had a normal Pap smear and HPV test 3 years ago.

The USPSTF concludes that there is insufficient evidence to recommend for or against screening for thyroid disease. The American College of Physicians recommends screening women over age 50 years who have at least one symptom that can be attributed to thyroid disease. The American Thyroid Association and the American Association of Clinical Endocrinologists recommend measuring thyroid-stimulating hormone (TSH) level in individuals with risk factors for hypothyroidism (for example, personal history of autoimmune disease, neck radiation, or thyroid surgery) and consideration of TSH testing in adults age 60 years and older. This patient does not have any symptoms of thyroid disease and therefore should not be screened.