Refinement of an osteoporosis risk-assessment questionnaire for use in community pharmacy

Abstract

Abstract Objective To explore the influence of bone mineral density (BMD) tests in osteoporosis risk categorisation in community pharmacies, and to develop a simple tool for pharmacists to use as a pre-BMD test screen. Method A secondary data analysis was conducted on the responses of 193 participants to a risk-assessment questionnaire, used in previous osteoporosis research that included a BMD test. To explore the impact of the BMD test on pharmacists' categorisation of risk, the researchers made an independent assessment based on responses of the questionnaire. The influence of risk factors on BMD scores/bone status was explored using multiple and logistic regression respectively. Key findings A total of responses of 193 participants were available for study, with 113 in the BMD group and 80 from the non-BMD group. In the BMD group, both researchers and pharmacists identified a similar proportion of patients in the moderate/high-risk category when BMD results were incorporated in the risk assessments (X2 = 0.78, degrees of freedom (df) = 1, 0.3 < P < 0.5). A statistically significant difference in risk categorisation was found between the pharmacists and researchers in the non-BMD group (X2 = 23.9, df = 1, P < 0.001). Risk factors identified to be significantly affecting BMD and of use for identifying patients at high risk for osteopenia/osteoporosis were age, weight, postmenopause and absence of hormone replacement therapy (HRT). These four factors were used to construct a simple risk index to guide pharmacists' initial risk categorisation. Conclusion The findings of this study suggested that BMD testing may increase the effectiveness of risk assessments and enhance the screening procedures in the community pharmacy. The simple risk index could serve as a pre-BMD test screen, with a BMD test recommended when necessary. A refined risk-assessment questionnaire could serve to guide pharmacists in directing individualised counselling and advice for at-risk patients, through identification of modifiable risk factors and conditions.