Osteoporosis Screening and Diagnosis - #55
Take QuizScreening for osteoporosis aims to identify patients at increased risk of fragility fractures who may benefit from an intervention to mitigate that risk.
Assessment should include all skeletal and non-skeletal factors that contribute to the risk. This is an important concept, because treatment may be indicated even if a person does not meet radiological criteria for osteoporosis. According to the National Osteoporosis Foundation (NOF), men and women age 50 and older should be evaluated for osteoporosis risk and the need for vertebral imaging or bone mineral density (BMD) testing (Table 1).
The USPSTF recommends (grade B evidence) screening:
• Women over the age of 65 years without previous known fractures or secondary causes
• Women <65 years whose10-year fracture risk (Table 2) is equal to or greater than that of a 65-year-old white woman without additional risk factors
• There is no specific screening recommendation for men without previous known fractures or secondary causes.
The NOF suggests different clinical indications for BMD assessment, including:
• Women age 65 years and men age 70 years and older, regardless of clinical risk factors and able and willing to initiate treatment
• Adults who have a fracture after age 50 years
Life-style Factors, Medical Conditions and Medications That Cause or Contribute to Osteoporosis and Fractures
Older adult in the outpatient setting
Identify primary or secondary prevention of fractures in the older adult based on assessment of risk factors for osteoporosis.
Osteoporosis is a silent disease that is often not identified until it is complicated by a fracture. Nearly 10 million Americans have osteoporosis and another 43 million have low bone density. About one out of every two Caucasian women and one in five men will experience an osteoporosis related fracture in their lifetime.
Eighty-six to 95 percent of low impact falls in persons with osteoporosis result in fractures. Hip fractures alone are associated with an 8-36% excess one-year mortality and 20% risk of long-term nursing home care. , While hip fracture rates are greater in women than men, mortality from hip fractures is greatest in men. Hip fractures are also associated with a 2.5 fold increase in secondary fracture, making secondary prevention of osteoporosis and falls imperative to post fracture treatment plans.
Science Principles
Risk Factors Included in the WHO Fracture Risk Assessment Model[i]
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Based on the tool, which can be accessed at: https://www.shef.ac.uk/FRAX/tool.jsp
[i] Kanis JA, Johnell O, Oden A, Johansson H and McCloskey E. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int. 2008; 19(4):385-397.
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Identify patients at risk for osteoporosis and apply screening recommendations
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Explain the key features to improving bone density and reducing the risk of fractures
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Identify persons who would benefit from medical therapy for osteoporosis
Review of Systems (ROS)
Geriatric Topics
Science Principles
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[1] National Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2014.
[1] Wright NC, Looker A, Saag K, Curtis JR, Dalxell ES, Randall S, Dawson-Hughes B. The recent prevalence of osteoporosis and low bone mass based on bone mineral density at the femoral neck or lumbar spine in the United States. Forethcoming 2014.
[1] Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C. Excess mortality following hip fracture: a systematic epidemiological review. Osteoporosis Int. 2009 20: 1633-50
[1] Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King AB, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Min Res. 2007; 22(3):465-475.
[1] Colon-Emeric C, Kuchibhatla M, Pieper C. The contribution of hip fracture to risk of subsequent fractures: data from two longitudinal studies. Osteoporos Int. 2003; 11:873-883.
[1] National Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2014.
[1] Nelson HD, Haney EM, Chou R, Dana T, Fu R, Bougatsos C. Screening for Osteoporosis: Systematic Review to Update in the 2002 US preventive Services Task Force Recommendation. Evidence Synthesis No. 77. AHRQ Publication No. 10-05145-EF-1. Rockville, ME:Agency for Healthcare Research and Quality, (US); July 2010.
[1] Kanis JA, Johnell O, Oden A, Johansson H and McCloskey E. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int. 2008; 19(4):385-397.
[1] Seeman E. Pathogenesis of bone fragility in women and med. Lancet. 2002; 359:1841-50.
Author Affiliations: Medical College of Wisconsin, Milwaukee, Wisconsin
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