History Of Low-trauma Fracture Research Articles

Bone mineral density and fractures in postmenopausal women of Maya-Mestizo ethnic origin with different body mass indexes

Background Obesity protects against bone loss, but it increases the risk of fragility fractures. Aim To determine if bone mineral density (BMD) and the prevalence of fractures are different in postmenopausal Maya-Mestizo women grouped according to their body mass index (BMI). Subjects and methods We studied 600 postmenopausal Maya-Mestizo women. A structured questionnaire for risk factors was applied. Body mass index was determined. BMD was assessed at the lumbar spine and total hip by dual-energy X-ray absorptiometry. History of low trauma fracture was determined from medical records. ANOVA was used to compare mean BMD between women with different BMI. To compare the frequency of fractures according to BMI group, we used χ 2 test. Results According to WHO classification of BMI, 16.3% of women had normal BMI, 35.3% were overweight, and 48.4% had obesity. We found that women with obesity had a higher BMD versus women with normal BMI or overweight in all the anatomical sites analysed. The prevalence of history of fractures was 18.2%. We did not find differences between the women of different BMI; the wrist was the most frequent skeletal site of the fracture. Conclusion Obesity in postmenopausal Maya-Mestizo women is not a risk factor for developing fragility fractures.

Ukrainian FRAX version in the male osteoporosis management

Background. At present, FRAX is a well-known and widely-used risk assessment tool for major osteoporotic fractures. The Ukrainian version of the FRAX algorithm was presented in 2016; with the “intervention threshold” for additional DXA examination and antiosteoporotic treatment of the Ukrainian women published in 2019. However, the data on its possible uses in men are limited. The purpose of the study was to evaluate the possibilities of using the previously developed criteria of the Ukrainian FRAX algorithm in Ukrainian men. Materials and methods. We examined 653 outpatients aged 40–88 years (mean age (M±SD)— 60.5±11.8 years). We analyzed the results both in the general group and in the age subgroups; in particular, with an account of low-trauma fractures, included in the FRAX calculation, and compared them with the corresponding indices of the Ukrainian women. Results. The most frequent (26.6 %) risk factor for osteoporotic fractures in the group of Ukrainian men was a history of low-trauma fracture (the corresponding index in women was 51.3 %), its presence being the reason for antiosteoporotic treatment initiating. Following upon the risk of major osteoporotic fractures calculated by FRAX, only 6.7 % of men without previous fractures were found to require additional DXA examination in order to re-evaluate the osteoporotic fracture risk, and none had a high fracture risk. 73 % of men without fractures did not have any risk factor included in the FRAX algorithm. Conclusions. This study showed a greater need for both antiosteoporotic treatment without DXA assessment and additional densitometric examination for the osteoporotic fracture risk assessment for the Ukrainian women rather than men, along with a special attention to the presence of previous fractures in men, and consideration of other risk factors for osteoporosis, even those not included in this FRAX algorithm.

Prevalence and risk factors of morphometric vertebral fracture in apparently healthy osteopenic postmenopausal Thai women.

To determine the prevalence of and risk factors for morphometric vertebral fracture (VF) in apparently healthy postmenopausal women with osteopenia. This cross-sectional study included 490 postmenopausal Thai women with osteopenia. All had no known history of low-trauma fracture, no underlying diseases, or history of taking medications that affect bone metabolism. Morphometric VFs were assessed by thoracolumbar spine x-rays, using the Genant semiquantitative method, and interpreted independently by three radiologists. Mean age of participants was 59.9 ± 7.8 years and mean body mass index was 24.3 ± 3.4 kg/m2. Morphometric VFs were present in 29% (142/490) of women (grade 1: 62.0%, grade 2: 19.3%, and grade 3: 18.7%). Of these, 4.9% were aged 50 years or less, 40.1% were aged 50-59 years, 38% were aged 60-69 years, and 16.9% were aged over 70 years. Age and the Fracture Risk Assessment Tool (FRAX) scores for hip and major osteoporotic fracture, with or without bone mineral density, were positively correlated with VF. No differences in fracture prevalence among those with various degrees of osteopenia. Applying the current guidelines for VF screening results in discoveries of less than a half of osteopenic women who have had morphometric VF. Almost one third of apparently healthy postmenopausal women with osteopenia had morphometric VF. Advancing age and greater FRAX scores were associated with higher prevalence of morphometric VF.

Baseline characteristics of postmenopausal women with osteoporosis treated with teriparatide in a real-world setting in Latin America: a subregional analysis from the Asia and Latin America Fracture Observational Study (ALAFOS)

BackgroundOsteoporosis is a major healthcare concern in Latin America. Factors such as changing demographics, fragmented healthcare systems, and financial considerations may result in a huge increase in the burden of osteoporosis in this region. The aim of this article is to describe the baseline clinical characteristics and fracture history of patients who are prescribed teriparatide in normal clinical practice in Latin America.MethodsWe conducted a prospective, multinational, observational study (the Asia and Latin America Fracture Observational Study [ALAFOS]) in 20 countries worldwide to assess the incidence of fractures in postmenopausal women with osteoporosis receiving teriparatide as a part of routine clinical practice in a real-world setting. In this subregional analysis of the ALAFOS study, we report the clinical characteristics, fracture history, risk factors for osteoporosis, comorbidities, previous osteoporosis therapies and health-related quality of life measures at baseline for patients from the four participant Latin American countries: Argentina, Brazil, Colombia, and Mexico.ResultsThe Latin America subregional cohort included 546 postmenopausal women (mean [SD] age: 71.0 [10.1] years; range: 40–94 years), constituting 18% of the ALAFOS total population. The baseline mean (SD) bone mineral density T-scores were − 3.02 (1.23) at the lumbar spine and − 2.31 (0.96) at the femoral neck; 62.8% of patients had a history of low trauma fracture after the age of 40 years and 39.7% of patients had experienced ≥1 fall in the past year. Osteoporosis medications were used by 70.9% of patients before initiating teriparatide. The median (Q1, Q3) EQ-5D-5 L Visual Analog Scale (VAS) scores for perceived health status at baseline was 70 (50, 80). The mean (SD) worst back pain numeric rating scale score for the overall Latin American cohort was 4.3 (3.4) at baseline.ConclusionsThis baseline analysis of the Latin America subregion of the ALAFOS study indicates that patients who are prescribed teriparatide in the four participant countries had severe osteoporosis and high prevalence of fractures. They also had back pain and poor health-related quality of life. The proportions of patients with severe or extreme problems on the EQ-5D-5 L individual domains were lower than those in the overall ALAFOS study population.

SAT-212 62-Year-Old Woman with Undiagnosed Kallman Syndrome: A Case of Missed Opportunities

Background: Kallman Syndrome (Isolated gonadotropin-releasing hormone (GnRH) deficiency with anosmia/hyposmia) affects both sexes but has male preponderance. The sex difference likely relates to genetics and possible early diagnosis in males because of microphallus and cryptorchidism. The presentation of Kallman syndrome in females may be very subtle and may lead to a delay in the diagnosis and management. Clinical Case A 62-year-old Caucasian female with a history of hypertension, hyperlipidemia, seizure disorder, COPD, multiple fractures and peripheral vascular disease was referred for evaluation of chronic hyponatremia that was diagnosed 6 years ago. The patient was euvolemic on the exam, and laboratory evaluation was consistent with SIADH. Labs showed Na 122-130 mmol/L, normal thyroid function and cortisol levels, serum Osm 259 mOsm/kg (Normal 280-300 mOsm/kg), urine Osm 565mOsm/kg (Normal 50-1200 mOsm/kg). Hyponatremia had been managed with fluid restriction and salt tablets. Other work-up was negative for malignancy. Unrelated to hyponatremia, the patient had striking virilization and hirsutism. On further history, she reported primary amenorrhea, infertility, lack of secondary sexual characteristics and anosmia. Physical exam was notable for absent secondary female sexual characteristics. Additional family history revealed a brother with anosmia and incomplete secondary sexual development and multiple females who never achieved puberty or fertility. Further workup included a normal pituitary MRI, and inappropriately low FSH of 1.0mIU/ml and LH of 0.3 m IU/ml (expected post-menopausal levels > 51 and 14, respectively). Other pituitary axis evaluation was normal. The patient also had a history of low trauma fractures of the hip and forearm. Bone density scan showed severe osteoporosis with a T-Score of -4.80 at the right femoral neck and -4.90 at the spine. Secondary osteoporosis work-up was negative. She was started on anabolic therapy with Teriparatide with plans to follow with antiresorptive therapy. Conclusion: This patient was diagnosed with hypogonadotropic hypogonadism due to Kallman Syndrome with severe osteoporosis. This case illustrates the value of physical exam and considering diagnoses and work up beyond the initial reason for consultation. A timely diagnosis in her case could have improved her quality of life, helped her achieve fertility and possibly may have prevented severe osteoporosis. The literature review also suggests a significant percentage of patients do not receive treatment for osteoporosis after hip fracture. (1) References 1-Solomon DH, Johnston SS, Boytsov NN, McMorrow D, Lane JM, Krohn KD. Osteoporosis Medication Use After Hip Fracture in U.S. Patients Between 2002 and 2011, J Bone Miner Res. 2014 Sep;29(9):1929-37.

Atteinte osseuse au cours de la mastocytose systémique

Mastocytosis are characterized by an abnormal tissular proliferation of mast cells in at least one visceral organ. Considering the accumulation of mast cells in the bone marrow, bone complications as osteoporosis with an increased risk of vertebral fractures can be observed. Bone involvement may also be the sole presentation of abnormal proliferation and the diagnosis of mastocytosis should be discussed in case of bone fragility in young patients. Bone complications are related to mast cell's infiltration and to mediators’ release by stimulated mast cells. Considering bone involvement, it is useful to assess bone mineral density (BMD) and to perform bone radiographs, for the assessment of vertebral fractures. There are very few data on the bone efficacy of mastocytosis treatments. Antiresorptive treatments as bisphosphonates are logical because of the key role of osteoclast and are indicated in patients with history of low trauma fracture and/or low BMD.

Validation of the Thai Osteoporosis Foundation and Royal College of Orthopaedic Surgeons of Thailand Clinical Practice Guideline for bone mineral density measurement in postmenopausal women

ObjectiveThe primary objective of this study was to determine the sensitivity, specificity, and predictive values of the Thai Osteoporosis Foundation (TOPF) and Royal College of Orthopaedic Surgeons of Thailand (RCOST) Clinical Practice Guideline for bone mineral density (BMD) measurement for the detection of postmenopausal osteoporosis. Its secondary objective was to find better indicators to detect postmenopausal osteoporosis. MethodsPostmenopausal women were enrolled in this study between June and December 2014. The clinical risk factors following TOPF and RCOST Clinical Practice Guideline for BMD measurement were collected. Bone mineral density was measured using dual energy X-ray absorptiometry. ResultsFour hundred postmenopausal women were enrolled in the study. The mean age of the studied population was 66.16 ± 6.04 years. Twenty-seven percent of the participants had either osteoporosis of the lumbar spine, femoral neck, or total hip, of which 13.3% had osteoporosis at the lumbar spine, 21.3% had osteoporosis at the femoral neck, and 2.5% had osteoporosis of the total hip. The sensitivity and specificity for detecting osteoporosis of the whole TOPF and RCOST guideline were 96.2% and 16.7%, 98.8% and 18.7%, 90.0% and 15.1%, and 97.2% and 19.5% at the lumbar spine, femoral neck, total hip, and any sites, respectively. Multiple logistic regression analysis revealed that only OSTA ≤−1, osteopenia on X-ray and low trauma fracture after age of 40 years were significant clinical risk factors in the detection of postmenopausal osteoporosis. The Receiver Operating Characteristics (ROC) curve was used to obtain the optimum probability value of osteoporosis at any sites which revealed that the probability value of 0.2222236 would have a sensitivity of 67% and specificity of 62% as the optimal cut point to detect osteoporosis. A simple flow diagram of “OSTA ≤−1”, “Osteopenia on X-ray” and “A history of low trauma fracture after age of 40 years” was developed as a better trade-off guideline for BMD measurement. ConclusionsThis study revealed that the TOPF and RCOST guideline for BMD measurement provided a high true positive rate of disease detection but with an expense of high false positive rate. The simple flow diagram was proposed as a more appropriate guideline for BMD measurement in postmenopausal women.

Multiple loading conditions analysis can improve the association between finite element bone strength estimates and proximal femur fractures: A preliminary study in elderly women

This is a preliminary case–control study on osteopenic/osteoporotic elderly women, testing the association of proximal femur fracture with minimum femoral strength, as derived from finite element (FE) analysis in multiple loading conditions.Fracture cases (n=22) in acute conditions were enrolled among low-trauma fractures admitted in various hospitals in the Emilia Romagna Region, Italy. Women with no history of low-trauma fractures were enrolled as controls (n=33). Patients were imaged with DXA to obtain aBMD, and with a bilateral full femur CT scan. FE-strength was derived in stance and fall configurations: (i) as the minimum strength among those obtained for multiple loading conditions spanning a domain of plausible force directions, and (ii) as the strength associated to the most commonly used single loading conditions. The association of FE-strength and aBMD with fractures was tested with logistic regression models, deriving odds ratios (ORs) and area under the receiver operating characteristic curve (AUC).FE-strength from multiple loading conditions better classified fracture cases from controls (OR per SD change=9.6, 95% CI=3.0–31.3, AUC=0.87 in stance; OR=9.5, 95% CI=2.9–31.2, AUC=0.88 in fall) compared to aBMD (OR=3.6, 95% CI=1.6–8.2, AUC=0.79 for total femur aBMD), while FE-strength results from the most commonly used single loading conditions were similar to aBMD. Only FE-strength from multiple loading conditions remained significant in age- and aBMD-adjusted models (OR=10.5, 95% CI=1.8–61.3, AUC=0.95).In summary, we highlighted the importance of considering different loading conditions to identify bone weakness, and confirmed that femoral FE-strength estimates may add value to aBMD predictions in elderly osteopenic/osteoporotic women.

FRAX®: Prediction of Major Osteoporotic Fractures in Women from the General Population: The OPUS Study

PurposesThe aim of this study was to analyse how well FRAX® predicts the risk of major osteoporotic and vertebral fractures over 6 years in postmenopausal women from general population.Patients and methodsThe OPUS study was conducted in European women aged above 55 years, recruited in 5 centers from random population samples and followed over 6 years. The population for this study consisted of 1748 women (mean age 74.2 years) with information on incident fractures. 742 (43.1%) had a prevalent fracture; 769 (44%) and 155 (8.9%) of them received an antiosteoporotic treatment before and during the study respectively. We compared FRAX® performance with and without bone mineral density (BMD) using receiver operator characteristic (ROC) c-statistical analysis with ORs and areas under receiver operating characteristics curves (AUCs) and net reclassification improvement (NRI).Results85 (4.9%) patients had incident major fractures over 6 years. FRAX® with and without BMD predicted these fractures with an AUC of 0.66 and 0.62 respectively. The AUC were 0.60, 0.66, 0.69 for history of low trauma fracture alone, age and femoral neck (FN) BMD and combination of the 3 clinical risk factors, respectively. FRAX® with and without BMD predicted incident radiographic vertebral fracture (n = 65) with an AUC of 0.67 and 0.65 respectively. NRI analysis showed a significant improvement in risk assignment when BMD is added to FRAX®.ConclusionsThis study shows that FRAX® with BMD and to a lesser extent also without FN BMD predict major osteoporotic and vertebral fractures in the general population.

Risk factors for fractures in patients with rheumatoid arthritis (preliminary results of the multicenter program «Osteoporosis in rheumatoid arthritis: Diagnosis, risk factors, fractures, treatment»)

Система комплексной поддержки и сопровождения научного журнала Elpub позволяет запустить двуязычный сайт журнала со встроенной системой электронной редакции в соответствии с лучшими издательскими практиками, а так же предусматривает техническую и методическую поддержку со стороны специалистов НЭИКОН.

Atteintes osseuses des mastocytoses systémiques

Mastocytosis are characterized by an abnormal tissular proliferation of mast cells in at least one visceral organ. Considering the accumulation of mast cells in the bone marrow, bone complications as osteoporosis with an increased risk of vertebral fractures can be observed. Bone involvement may also be the sole presentation of abnormal proliferation and the diagnosis of mastocytosis should be discussed in case of bone fragility in young patients. Bone complications are related to mast cell's infiltration and to mediators’ release by stimulated mast cells. Considering bone involvement, it is useful to assess bone mineral density (BMD) and to perform bone radiographs, especially for the assessment of vertebral fractures. There are very few data on the bone efficacy of mastocytosis treatments. Antiresorptive treatments as bisphosphonates are logical in patients with history of low trauma fracture and/or low BMD.

Can Early Onset of Disease Be One of the Risk Factors for Low Bone Mineral Density in Patients with Inflammatory Bowel Disease?

Can Early Onset of Disease Be One of the Risk Factors for Low Bone Mineral Density in Patients with Inflammatory Bowel Disease?

Women with previous fragility fractures can be classified based on bone microarchitecture and finite element analysis measured with HR-pQCT

High-resolution peripheral quantitative computed tomography (HR-pQCT) measurements of distal radius and tibia bone microarchitecture and finite element (FE) estimates of bone strength performed well at classifying postmenopausal women with and without previous fracture. The HR-pQCT measurements outperformed dual energy x-ray absorptiometry (DXA) at classifying forearm fractures and fractures at other skeletal sites. Areal bone mineral density (aBMD) is the primary measurement used to assess osteoporosis and fracture risk; however, it does not take into account bone microarchitecture, which also contributes to bone strength. Thus, our objective was to determine if bone microarchitecture measured with HR-pQCT and FE estimates of bone strength could classify women with and without low-trauma fractures. We used HR-pQCT to assess bone microarchitecture at the distal radius and tibia in 44 postmenopausal women with a history of low-trauma fracture and 88 age-matched controls from the Calgary cohort of the Canadian Multicentre Osteoporosis Study (CaMos) study. We estimated bone strength using FE analysis and simulated distal radius aBMD from the HR-pQCT scans. Femoral neck (FN) and lumbar spine (LS) aBMD were measured with DXA. We used support vector machines (SVM) and a tenfold cross-validation to classify the fracture cases and controls and to determine accuracy. The combination of HR-pQCT measures of microarchitecture and FE estimates of bone strength had the highest area under the receiver operating characteristic (ROC) curve of 0.82 when classifying forearm fractures compared to an area under the curve (AUC) of 0.71 from DXA-derived aBMD of the forearm and 0.63 from FN and spine DXA. For all fracture types, FE estimates of bone strength at the forearm alone resulted in an AUC of 0.69. Models based on HR-pQCT measurements of bone microarchitecture and estimates of bone strength performed better than DXA-derived aBMD at classifying women with and without prior fracture. In future, these models may improve prediction of individuals at risk of low-trauma fracture.

Epidemiological Data on Osteoporosis in Women From the RAC-OST-POL Study

In the RAC-OST-POL study, epidemiological data were presented concerning osteoporosis in 625 women older than 55yr coming from the District of Raciborz in Poland. The mean age was 66.4±7.8yr. All the women fulfilled a questionnaire, gathering data on clinical risk factors of osteoporosis. Femoral neck (FN) and total hip (TH) were measured. The mean value of bone mineral density for FN was 0.862±0.129g/cm2, T-score −1.25±0.92, and Z-score 0.039±0.78, whereas the respective values for TH were 0.945±0.149g/cm2, −0.47±1.19, and 0.52±0.98. T-score for FN below −2.5 was noted in 59 women (9.5%) and for TH in 23 women (3.7%). One hundred seventy six women reported prior osteoporotic fracture(s) (28.2%). Falls were the most common clinical risk factor. The number of clinical risk factors was significantly higher in subjects with fracture history than in those without fracture records. The only first-line antiresorptive medications, used in the therapy for osteoporosis, included alendronate—42 subjects (6.7%). Estrogen therapy was prescribed in 135 women and 7 were treated with calcitonin. Calcium was administered in 94 patients and vitamin D in 84 women. In all the women on therapy, Z-score values were significantly lower than in untreated women. Concluding, the results of our epidemiological study demonstrate low treatment rate in women with history of low trauma fracture. Effective strategies are needed for prevention, especially in regard to falls, and management of this disease, in particular for improvement of the treatment rates in affected women with prior fracture, in general.

Knochendichtemessung am wachsenden Skelett und klinische Konsequenzen

The measurement of bone mineral density (BMD) was established to judge the fracture risk in an individual. The most commonly used densitometric technique DXA is a two-dimensional method and reports BMD (bone mass/projection area), which increases during growth. Bone mineral density (in g/cm(3)), however, is almost stable and does not change with age or height. To analyze the data special pediatric references including data on age, sex and ethnicity are necessary as well as correction for height. Bone forms a unit with muscle. Bone responds to mechanical loading with increase in bone size and therefore adapts to the biomechanical needs. Therefore, interpretation of bone development data requires data on muscle development.The indication for bone mineral density measurement and result reporting should be made by and together with a pediatric specialist. The diagnosis of osteoporosis should not be made based solely on densitometric measurements. History of low trauma fracture is an important aspect for the definition. Besides DXA there exist further methods with advantages and disadvantages.

Bone microarchitecture in hemodialysis patients assessed by HR-pQCT.

Dialysis patients are at high risk for low-trauma bone fracture. Bone density measurements using dual-energy x-ray absorptiometry (DXA) do not reliably differentiate between patients with and without fractures. The aim of this study was to identify differences in bone microarchitecture between patients with and without a history of fracture using high-resolution peripheral quantitative computed tomography (HR-pQCT). Seventy-four prevalent hemodialysis patients were recruited for measurements of areal bone mineral density (aBMD) by DXA and bone microarchitecture by HR-pQCT. Patients with a history of trauma-related fracture were excluded. Forty healthy volunteers served as controls. Blood levels of parathyroid hormone, vitamin D, and markers of bone turnover were determined. Dialysis patients, particularly women, had markedly impaired bone microarchitecture. Patients with fractures had significantly reduced cortical and trabecular microarchitecture compared with patients without fractures. aBMD tended to be lower in patients with fractures, but differences were statistically not significant. The strongest determinant of fracture was the HR-pQCT-measured trabecular density of the tibia, which also had the highest discriminatory power to differentiate patients according to fracture status. Radial DXA had a lower discriminatory power than trabecular density. Bone microarchitecture is severely impaired in dialysis patients and even more so in patients with a history of fracture. HR-pQCT can identify dialysis patients with a history of low-trauma fracture.

Low rates of treatment in postmenopausal women with a history of low trauma fractures: results of audit in a Fracture Liaison Service

A past history of low trauma fracture is a strong risk factor for future fractures in postmenopausal women and national guidance recommends treatment in the majority of such women To establish the prevalence of bone protective therapy use in postmenopausal women with a history of low trauma fracture Design and Clinical audit of 1641 postmenopausal women presenting with a low trauma fracture to the Fracture Liaison Service at Addenbrooke's Hospital, Cambridge between January 2006 and December 2007. A total of 526 (31%) women presenting with a fracture had a past history of fracture, defined as a low trauma fracture after the age of 45 years. The wrist was the most common site of previous fracture, followed by hip, hand or foot, lower leg and humerus. Of these women, only 27.6% were receiving bone protective therapy with a bisphosphonate (89%) or other medication. Calcium and vitamin D supplements were received by 35.6%. The highest rates of treatment were seen for spine and hip fracture (61.9 and 49.3%, respectively). Only 45.1% of women aged 75 years and over with a previous history of fracture were receiving bone protective therapy. The results of our audit demonstrate low rates of treatment in postmenopausal women with a history of low trauma fracture. Better education of healthcare professionals, more consistent recording of fractures in primary care and the use of clearly defined care pathways that involve patients and their carers provide rational approaches to reducing this care gap.

Factors Determining Screening for Osteoporosis in Inflammatory Bowel Disease - Are We Following Guidelines?

Purpose: Osteoporosis is a well recognized morbidity associated with Inflammatory Bowel Disease (IBD) with a significant impact on patient's health. The aim of this study is to evaluate the practice of management of osteoporosis in a tertiary care center's out patient IBD clinic and its variance from the proposed guidelines. Methods: A retrospective chart review of 204 IBD patients was conducted and the following data was recorded: age, gender, race, disease duration, body weight, diagnosis of Ulcerative colitis (UC) or Crohn's disease (CD), location of disease, surgeries in past, use of steroids, anti-TNF agents, calcium and vitamin D supplements, bisphosphonate use, dual energy X-ray absorptiometry (DEXA) scans and their results, any osteoporosis related complications as documented in the chart. Data was then compared to American Gastroenterology Association guidelines for management of osteoporosis published in 2003. Risk Factors assessed were history of low trauma fracture, smoking, advanced age>60 years, post menopausal state, steroid use >3months or current use and low body weight. Results: Out of 204 charts reviewed- 70 patients (mean age-41.8 years, 57% males, 42.8% females) were referred for a DEXA scan and 134 patients (mean age-40.4 years, 46% males, 53% females) were not referred for a DEXA scan. Both groups were predominantly Caucasian. There was no significant difference in disease type-UC versus CD. One hundered and fifty three patients had any of the above mentioned risk factors for osteoporosis. Only 34.6 % of these patients were referred for a DEXA scan. Out of which 15% had osteoporosis and 41.5 % had osteopenia. No risk factors were found in 51 patients, 31% of who were referred for a DEXA scan- 6 % had osteoporosis and 31 % had osteopenia. Table 1 compares the risk factors and significant demographics of patients referred for a DEXA scan and those who were not. Patients with longer duration of follow up(p=0.0138) and steroid use irrespective of duration of use(p=0.017) were found to be significant factors influencing referral for a DEXA scan.Table 1: Comparison of risk factors and demographics between patients referred for DEXA scan and those who were notConclusion: Guidelines for osteoporosis screening were followed approximately for one-third of the population that met criteria and the rate of osteoporosis (15%) detected was concordant with rates reported in previously done studies. Incidence of osteoporosis was much lower in patients with no risk factors. Decision to refer a patient for DEXA scan was influenced by factors other than those recommended by AGA guidelines.

Assessing the True Impact of Recurrent Fractures on Fracture Risk

Assessing the True Impact of Recurrent Fractures on Fracture Risk

Factors Associated with Osteoporosis Screening and Recommendations for Osteoporosis Screening in Older Adults

ABSTRACTBACKGROUNDOsteoporosis screening rates are low, and it is unclear which patient factors are associated with screening and physician recommendations for screening.OBJECTIVETo identify patient characteristics associated with osteoporosis screening recommendations and receipt of screening in older adults.DESIGNCross-sectional mailed survey.PARTICIPANTSWomen and men ≥60 years old living in or near western Pennsylvania.MEASUREMENTSSociodemographic characteristics and osteoporosis-related data, including risk factors, physician recommendations for screening, and receipt of screening. Multivariable logistic regression analyses were performed to determine odds ratios for receipt of screening and screening recommendations for individuals with particular osteoporosis risk factors, adjusting for sociodemographic and other risk factors.RESULTSSurveys were completed by 1,268 of the 1,830 adults to whom surveys were mailed (69.3%). Most respondents were white (92.9%), female (58.7%), and believed they were in good to excellent health (88.2%). Only 47.6% said their physician recommended osteoporosis screening, and 62.6% of all respondents reported being screened. Screening recommendations were less likely for older respondents than younger ones (OR, 0.87 per 5-year increase in age; 95% CI, 0.77–0.97). Individuals with osteoporosis risk factors of a history of oral steroid use for >1 month, height loss >2.54 cm, or history of low-trauma fracture were no more likely to report screening recommendations than individuals without these characteristics. Receipt of screening was no more likely for more elderly respondents or respondents with a history of oral steroid use for >1 month than for respondents without these characteristics.CONCLUSIONSIndividuals with several known osteoporosis risk factors are not being sufficiently targeted for screening.