Osteoporosis Screening and Diagnosis

Osteoporosis Screening and Diagnosis - #55

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Screening for osteoporosis aims to identify patients at increased risk of fragility fractures who may benefit from an intervention to mitigate that risk.

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.

Risk Factors Included in the WHO Fracture Risk Assessment Model[i]

 

  • Current age >65 years
  • Rheumatoid arthritis
  • Female gender
  • Secondary causes of osteoporosis: Type I diabetes, osteogenesis imperfecta in adults, untreated long-standing hyperthyroidism, hypogonadism or premature menopause (<40), chronic malnutrition or malabsorption and chronic liver disease
  • Height and weight (low BMI)
  • Parental history of a hip fracture
  • Prior osteoporotic fracture (including asymptomatic vertebral fractures
  • Current smoking
  • Oral glucocorticoids >5mg/d for >3mo (ever)
  • Alcohol intake (3 or more drinks/day)

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.

  1. Identify patients at risk for osteoporosis and apply screening recommendations

  2. Explain the key features to improving bone density and reducing the risk of fractures

  3. Identify persons who would benefit from medical therapy for osteoporosis

  1. [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.

     

You voted '2'.
This GFF ___ my competence in geriatrics.

Katherine Ritchey, DO, MPH

Clinical Faculty, Geriatrics and Extended Care, VA Puget Sound Health Care System

Division of Geriatrics and Gerontology, University of Washington

 

 

Thuan Ong, MD, MPH

Assistant Professor

Division of Geriatrics and Gerontology, University of Washington

The Medical College of Wisconsin