Screening In Postmenopausal Women Research Articles

Association between risk factors and bone mineral density and the development of a self-assessment tool for early osteoporosis screening in postmenopausal women with type 2 diabetes.

Both diabetes and osteoporosis have developed into major global public health problems due to the increasing aging population. It is crucial to screen populations at higher risk of developing osteoporosis for disease prevention and management in postmenopausal women with type 2 diabetes (T2D). This study aims to quantitatively investigate the association between risk factors and bone mineral density (BMD) and develop a self-assessment tool for early osteoporosis screening in postmenopausal women with T2D. We retrospectively enrolled 1,309 postmenopausal women with T2D. Linear regression methods were used to assess the association between risk factors and BMD. Additionally, a multivariate logistic regression analysis was performed to identify independent risk factors associated with osteoporosis. Utilizing the logistic regression machine learning algorithm, we developed an osteoporosis screening tool that categorizes the population into three risk regions based on age and body mass index (BMI), indicating low, moderate, and high prevalence of osteoporosis in the age-BMI plane. Older age and lower BMI were independently associated with decreased BMD. The BMD at the total hip, femur neck, and lumbar spine differed by 12.9, 10.9, and 15.5 mg/cm2 for each 1 unit increase in BMI, respectively. Both age and BMI were identified as independent predictors of osteoporosis. The osteoporosis screening tool was developed by using two straight lines with equations of BMI = 0.56 * age-4.12 and BMI = 0.56 * age-10.88; there were no significant differences in the prevalence of osteoporosis among the training, internal test, and external test datasets in the low-, moderate-, and high-risk regions. We have successfully developed and validated a self-assessment tool for early osteoporosis screening in postmenopausal women with T2D for the first time. BMI was identified as a significant modifiable risk factor. Our study may improve awareness of osteoporosis and is valuable for disease prevention and management for postmenopausal women with T2D.

Metabolic syndrome clustering patterns and the association with cardiovascular disease among post-menopausal Korean women

The metabolic syndrome (MetS) is a group of diseases conceptualized as a clustering of risk factors, with the risks of developing MetS in women varying significantly before and after menopause. This study investigated MetS clustering patterns and their association with cardiovascular disease (CVD) risk among post-menopausal women (n = 2479) using data from the Korean Genome Epidemiology Study. Using latent class analysis, three groups emerged: diabetic (5.6%), hypertensive (35.2%), and low-risk (59.2%). Relative to the low-risk group, the diabetic group demonstrated associations with older age, a family history of chronic disease, an increased Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), an elevated white blood cell (WBC) count, experience with hysterectomy, being a non-drinker, more physical activity, and excessive sleep. The hypertensive group was associated with older age, lower monthly income, a family history of chronic disease, increased HOMA-IR, a higher WBC count, more physical activity, and excessive sleep. The diabetic and hypertensive groups had a significantly higher CVD risk than the low-risk group (diabetic: odds ratio [OR] = 2.41 [1.11, 5.27]; hypertensive: OR = 2.46 [1.33, 4.55]). This study identified potential markers for MetS screening in post-menopausal women, highlighting the need for early intervention and personalized healthcare for middle-aged women to reduce CVD risk following menopause.

Cone Beam Computed Tomography Panoramic Mandibular Indices in the Screening of Postmenopausal Women with Low Bone Mass: Correlations with Bone Quantity and Quality.

This study examined the potential use of computed tomography panoramic mandibular indices on cone beam CT (CBCT) for assessing bone density in postmenopausal women with low bone mass. The study enrolled 104 postmenopausal women who underwent dual-energy X-ray absorptiometry (DXA) using a DXA scanner and mental foramen region CBCT alongside the NewTom VGi EVO Cone Beam 3D system. We assessed the relationship between the following DXA parameters: lumbar, femoral neck, and total hip T score, bone mineral density (BMD), and lumbar trabecular bone score (TBS). The following panoramic mandibular indices were also considered: the computed tomography mandibular index superior (CTI(S)), computed tomography mandibular index inferior (CTI(I)), and computed tomography mental index (CTMI). The study revealed moderate correlations between CBCT indices and BMD/TBS scores: CTMI showed the highest correlation with the femoral neck T-score (r = 0.551, p < 0.0001). TBS scores were also moderately correlated with CBCT indices: CTMI showed a moderate positive correlation with TBS (r = 0.431, p < 0.0001); CTI(S) had a similar moderate positive correlation with TBS (r = 0.421, p < 0.0001). AUC values ranged from 0.697 to 0.733 for osteoporosis versus the osteopenia/normal group and from 0.734 to 0.744 for low versus normal bone quality groups, p < 0.0001. The comparison of the values of the studied indices between low versus normal bone quality (quantified with TBS) groups showed high sensitivity but low specificity. CBCT-measured indices CTI(S), CTI(I), and CTMI are useful in assessing patients with low bone mass to improve, by specific treatment, the prognosis of dental implants.

Necessity of Osteoporosis Screening in Postmenopausal Women

Abstract not available IAHS Medical Journal Vol 5(1), June 2022; 1-2

Selection of risk assessment methods for osteoporosis screening in postmenopausal women with low-energy fractures: A comparison of fracture risk assessment tool, digital X-ray radiogrammetry, and dual-energy X-ray absorptiometry.

Objectives:Fracture liaison services are designed to identify patients needing osteoporosis treatment after a fracture. Some fracture liaison service designs involve a prescreening step, for example, fracture risk assessment tool (FRAX®). Another possible prescreening tools are bone mass density assessment in the acute setting. The aim of this study was to assess the effectiveness of prescreening tools.Methods:In the present prospective cohort study, women aged >55 years with a radius fracture were included. Patients were recruited at the emergency department after experiencing their fracture. All patients performed fracture risk assessment by fracture risk assessment tool, and bone mass density assessment by digital X-ray radiogrammetry and dual-energy X-ray absorptiometry (prescreening steps) as well as full routine evaluation at the osteoporosis unit (endpoint). The main outcome measures were sensitivity, specificity, predictive values, and area under the curve.Results:Forty-one women were recruited (mean age: 70 ± 8 years). Of these, 54% fulfilled the treatment indication criteria of osteoporosis after a full examination. Fracture risk assessment tool without bone mass density (cutoff ⩾ 15%) for prescreening patients had a high sensitivity (90%) but a low area under the curve (0.50) and specificity (16%). The highest area under the curve (0.73) was found prescreening with bone mass density assessment (dual-energy X-ray absorptiometry or digital X-ray radiogrammetry) having a sensitivity of 59%–86% and specificity of 61%–90%.Conclusion:This study, though small, raises questions regarding the effectiveness of using a prescreening step in fracture liaison services for high-risk individuals. In this cohort, FRAX® without bone mass density had a low precision, with a risk of both underestimating and overestimating patients requiring treatment. Bone mass density assessment in the acute setting could improve the precision of prescreening. Further investigations on the effectiveness and health economics of prescreening steps in fracture liaison services are needed.

Cervical Cancer Screening in Postmenopausal Women: Is It Time to Move Toward Primary High-Risk Human Papillomavirus Screening?

Background: Cervical cytology in postmenopausal women is challenging due to physiologic changes of the hypoestrogenic state. Misinterpretation of an atrophic smear as atypical squamous cells of uncertain significance (ASCUS) is one of the most common errors. We hypothesize that high-risk human papillomavirus (hrHPV) testing may be more accurate with fewer false positive results than co-testing of hrHPV and cervical cytology for predicting clinically significant cervical dysplasia in postmenopausal women. Materials and Methods: We conducted a retrospective analysis of 924 postmenopausal and 543 premenopausal women with cervical Pap smears and hrHPV testing. Index Pap smear diagnoses (ASCUS or greater vs. negative for intraepithelial lesion) and hrHPV testing results were compared with documented 5-year clinical outcomes to evaluate sensitivity and specificity of hrHPV compared with co-testing. Proportions of demographic factors were compared between postmenopausal women who demonstrated hrHPV clearance versus persistence. Results: The prevalence of hrHPV in premenopausal and postmenopausal women was 41.6% and 11.5%, respectively. The specificity of hrHPV testing (89.6% [87.4-91.5]) was significantly greater compared with co-testing (67.4% [64.2-70.4]) (p < 0.05). A greater proportion of women with persistent hrHPV developed cervical intraepithelial lesion 2 or greater (CIN2+) compared with women who cleared hrHPV (p = 0.012). No risk factors for hrHPV persistence in postmenopausal women were identified. Conclusion: Our data suggest that hrHPV testing may be more accurate than co-testing in postmenopausal women and that cytology does not add clinical value in this population. CIN2+ was more common among women with persistent hrHPV than those who cleared hrHPV, but no risk factors for persistence were identified in this study.

Utility of cervical pap smears in screening of postmenopausal women

Introduction: Cervical cancer is one of the most preventable and curable cancer. The papanicolaou cervical cytology test is capable of detecting cervical cancer at an early stage and is widely used in developed countries, where it has decreased both the incidence and mortality of cervical cancer. Therefore, it is important to investigate the significance of screening in postmenopausal women. Objectives of the study: To study the cytomorphology of different cervical lesions among postmenopausal women. To determine the significance of cervical cancer screening in symptomatic and asymptomatic postmenopausal women. Materials and Methods: A prospective study of one year duration from January 2017 to December 2017 was conducted in the department of pathology of our institution. The conventional cervical pap smears of postmenopausal women were obtained from the department of gynaecology and reported according to the 2014 Bethesda system. Results: Out of the 198 smears of postmenopausal women screened, 17 (8.6%) were normal smears, 12 (6.1%) were atropic, 97(48.9%) were inflammatory smears. Atypical squamous cells of undetermined significance (ASC-US) were 31(15.7%) cases, 10(5.1%) were reactive cellular changes associated with inflammation, 06 (3.0%) were low grade squamous intraepithelial lesion (LSIL), 08 (4.0%) were high grade squamous intraepithelial lesion (HSIL) and 01 (0.5%) case of squamous cell carcinoma was observed in our study. 16(8.1%) smears were unsatisfactory for evaluation. Conclusion: The risk of cervical cancer increases as the age advances, therefore postmenopausal women should be screened with cervical Pap smears for early detection and better management. Keywords: Pap smear, Postmenopausal women, Screening.

Development and Validation of a Serum Metabolomic Signature for Endometrial Cancer Screening in Postmenopausal Women

Endometrial carcinoma (EC) is the most commonly diagnosed gynecologic cancer. Its early detection is advisable because 20% of women have advanced disease at the time of diagnosis. To clinically validate a metabolomics-based classification algorithm as a screening test for EC. This diagnostic study enrolled 2 cohorts. A multicenter prospective cohort, with 50 cases (postmenopausal women with EC; International Federation of Gynecology and Obstetrics stage I-III and grade G1-G3) and 70 controls (no EC but matched on age, years from menopause, tobacco use, and comorbidities), was used to train multiple classification models. The accuracy of each trained model was then used as a statistical weight to produce an ensemble machine learning algorithm for testing, which was validated with a subsequent prospective cohort of 1430 postmenopausal women. The study was conducted at the San Giovanni di Dio e Ruggi d'Aragona University Hospital of Salerno (Italy) and Lega Italiana per la Lotta contro i Tumori clinic in Avellino (Italy). Data collection was conducted from January 2018 to February 2019, and analysis was conducted from January to March 2019. The presence or absence of EC based on evaluation of the blood metabolome. Metabolites were extracted from dried blood samples from all participants and analyzed by gas chromatography-mass spectrometry. A confusion matrix was used to summarize test results. Performance indices included sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and accuracy. Confirmation or exclusion of EC in women with a positive test result was by means of hysteroscopy. Participants with negative results were followed up 1 year after enrollment to investigate the appearance of EC signs. The study population consisted of 1550 postmenopausal women. The mean (SD) age was 68.2 (11.7) years for participants with no EC in the training cohort, 69.4 (13.8) years for women with EC in the training cohort, and 59.7 (7.7) years for women in the validation cohort. Application of the ensemble machine learning to the validation cohort resulted in 16 true-positives, 2 false-positives, and 0 false-negatives, and it correctly classified more than 99% of samples. Disease prevalence was 1.12% (16 of 1430). In this study, dried blood metabolomic profile was used to assess the presence or absence of EC in postmenopausal women not receiving hormonal therapy with greater than 99% accuracy.

Cervical Cancer Screening in Postmenopausal Women Referring to Hamadan Comprehensive Health Centers

1- Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran 2- Assistant Professor, Maternal and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran , aghababaii@yahoo.com 3- Associate Professor, Department of Biostatistics, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran 4- School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran

Does osteoporosis screening in postmenopausal women prevent fractures?

EVIDENCE-BASED ANSWER The effect of osteoporosis screening in postmenopausal women is unclear. In a mixed population of pre- and postmenopausal women, osteoporosis screening increases the use of medications to treat osteoporosis and slightly decreases all fractures by an absolute difference of 0.6%, but does not decrease osteoporotic fractures of the hip, lumbar spine, femur, or wrist (SOR: B, RCT). In a mixed male and female population 65 years of age and older, screening is associated with 3.4 fewer hip fractures per 1,000 patients (SOR: B, cohort trial). Screening for osteoporosis is recommended in women 65 years and older, and younger women with similar risk to a white woman 65 years of age without other risk factors (SOR: B, evidence-informed guidelines).

Cost-effectiveness of Virtual Bone Strength Testing in Osteoporosis Screening Programs for Postmenopausal Women in the United States.

Purpose To investigate whether assessment of bone strength with quantitative computed tomography (CT) in combination with dual-energy x-ray absorptiometry (DXA) is cost-effective as a screening tool for osteoporosis in postmenopausal women. Materials and Methods A state-transition microsimulation model of osteoporosis for postmenopausal women aged 55 years or older was developed with a lifetime horizon and U.S. societal perspective. All model inputs were derived from published literature. Three strategies were compared: no screening, DXA with T score-dependent rescreening intervals, and a combination of DXA and quantitative CT with different intervals (3, 5, and 10 years) at different screening initiation ages (55-65 years). Oral bisphosphonate therapy was started if DXA hip T scores were less than or equal to -2.5, 10-year risk for hip fracture was greater than 3% (World Health Organization Fracture Risk Assessment Tool score, or FRAX), 10-year risk for major osteoporotic fracture was greater than 20% (FRAX), quantitative CT femur bone strength was less than 3000 N, or occurrence of first fracture (eg, hip, vertebral body, wrist). Outcome measures were incremental cost-effectiveness ratios (ICERs) in 2015 U.S. dollars per quality-adjusted life year (QALY) gained and number of fragility fractures. Probabilistic sensitivity analysis was also performed. Results The most cost-effective strategy was combined DXA and quantitative CT screening starting at age 55 with quantitative CT screening every 5 years (ICER, $2000 per QALY). With this strategy, 12.8% of postmenopausal women sustained hip fractures in their remaining life (no screening, 18.7%; DXA screening, 15.8%). The corresponding percentages of vertebral fractures for DXA and quantitative CT with a 5-year interval, was 7.5%; no screening, 11.1%; DXA screening, 9%; for wrist fractures, 14%, 17.8%, and 16.4%, respectively; for other fractures, 22.6%, 30.8%, and 27.3%, respectively. In probabilistic sensitivity analysis, DXA and quantitative CT at age 55 years with quantitative CT screening every 5 years was the best strategy in more than 90% of all 1000 simulations (for thresholds of $50 000 per QALY and $100 000 per QALY). Conclusion Combined assessment of bone strength and bone mineral density is a cost-effective strategy for osteoporosis screening in postmenopausal women and has the potential to prevent a substantial number of fragility fractures. © RSNA, 2017 Online supplemental material is available for this article.

Bone Density Screening in Postmenopausal Women With Early-Stage Breast Cancer Treated With Aromatase Inhibitors.

In postmenopausal women with breast cancer treated with aromatase inhibitors (AIs), most expert panels advise baseline bone mineral density testing with a dual-energy x-ray absorptiometry (DXA) scan repeated every 1 to 2 years. How often this recommendation is followed is unclear. We performed a retrospective analysis of women with stage I to III breast cancer who started AI therapy from January 1, 2008, to December 31, 2010, with follow-up through December 31, 2012, by using the SEER-Medicare database. Selection criteria included AI use for ≥ 6 months and no recent osteoporosis diagnosis or bisphosphonate use. We used multivariable logistic regression to investigate associations between patient characteristics and receipt of a baseline DXA scan. In patients who continued AI treatment, we assessed rates of follow-up scans. In the sample of 2,409 patients (median age, 74 years), 51.0% received a baseline DXA scan. Demographic characteristics associated with the absence of a baseline DXA scan were older age (85 to 94 years v 67 to 69 years; odds ratio [OR], 0.62; 95% CI, 0.42 to 0.92) and black v white race (OR, 0.68; 95% CI, 0.47 to 0.97). Among patients who underwent a baseline DXA scan and continued AI for 3 years, 28.0% had a repeat DXA scan within 2 years and 65.9% within 3 years. In aggregate, of the 1,164 patients who continued with AI treatment for 3 years, only 34.5% had both a baseline and at least one DXA scan during the 3-year follow-up period. The majority of older Medicare beneficiaries with breast cancer treated with AIs do not undergo appropriate bone mineral density evaluation.

Bone density screening in postmenopausal women with early-stage breast cancer on aromatase inhibitors.

6599Background: In postmenopausal females with breast cancer on aromatase inhibitors (AIs), most expert panels advise baseline bone mineral density (BMD) testing with a dual-energy X-ray absorptiom...

Osteoporosis screening in postmenopausal women aged 50–64 years: BMI alone compared with current screening tools

ObjectivesConsensus on when to initiate DXA screening for early postmenopausal women (<65 years of age) is lacking. Low body mass index (BMI) has been proposed as one of the major risk factors for osteoporosis. This study sought to compare the predictive performance of BMI alone with 5 screening modalities (the U.S. Preventive services task force [USPSTF] FRAX threshold of 9.3%, a risk factor based approach [≥1 risk factors], the osteoporosis self-assessment tool [OST <2], the osteoporosis risk assessment instrument [ORAI ≥9], and the simple calculated osteoporosis risk estimation [SCORE ≥6]) in identifying early postmenopausal women with osteoporosis. MethodsPostmenopausal women aged 50–64 years presenting for a DXA test were recruited between January 1, 2007, and March 1, 2009. Demographic data and osteoporosis risk factors were obtained through a telephone survey. The performance of each screening tool in predicting osteoporosis was compared. ResultsOf 445 study participants, 95% were White, 38 had osteoporosis (T-score ≤−2.5). BMI (<28) was associated with the highest Sensitivity (95%), the lowest Negative Likelihood Ratio (LR-) of 0.14, an AUC of 0.73, and the number needed to scan (NNS) of 8. The USPSTF approach had the lowest sensitivity (24%), highest LR- (0.91), lowest AUC (0.62), and highest NNS (9). Among 5 established modalities, SCORE (≥6) appears to be the best (sensitivity: 92%, LR-: 0.24, AUC: 0.75, NNS: 9). ConclusionBMI (<28) had a comparable numerical screening performance overall to the current screening modalities. BMI (<28) could be considered a potential indicator when screening early postmenopausal White women for osteoporosis. However, a better osteoporosis screening tool remains to be developed.

Bone Density Screening and Re-screening in Postmenopausal Women and Older Men.

Clinical practice guidelines universally recommend bone mineral density (BMD) screening to identify osteoporosis in women aged 65 years and older. Risk assessment is recommended to guide BMD screening in postmenopausal women under age 65. Insufficient data are available to inform standard ages to start and stop BMD screening in postmenopausal women. Based on longitudinal studies of incident osteoporosis and fracture in postmenopausal women, an initial BMD test should be ordered for all women aged 65, and the frequency of re-screening should be based on age and BMD T score (more frequent testing for older age and lower T score). Although clinical practice guidelines recommend BMD screening according to risk factors for fracture in postmenopausal women under age 65, no standard approach to risk assessment exists. Minimal evidence is available to guide osteoporosis screening in men, but some experts recommend initiation of BMD screening in men at age 70.

Risk Assessment Tools for Osteoporosis Screening in Postmenopausal Women: A Systematic Review

Osteoporotic fractures are common in postmenopausal women. Tools are available to estimate the risk of low bone mineral density (BMD) or fracture. This systematic review retrieved articles that evaluated osteoporosis risk assessment tools among postmenopausal women in North America. For identifying BMD T-score ≤-2.5, most studies of the Simple Calculated Osteoporosis Risk Estimation tool (SCORE) and Osteoporosis Risk Assessment Instrument (ORAI) reported sensitivity ≥90 %. Area under the receiver operating characteristic curve (AUC) was usually <0.75 for SCORE and ≥0.75 for ORAI. Among women 50-64 years old, a Fracture Risk Assessment Tool (FRAX) threshold ≥9.3 % had a sensitivity of 33 % for identifying BMD T-score ≤-2.5 and 26 % for predicting major osteoporotic fracture (MOF). For predicting MOF, sensitivity was higher for SCORE and Osteoporosis Self-assessment Tool equation (OST), and higher in women ≥65 years old. For predicting BMD T-score ≤-2.5 in women ≥65 years old, the sensitivities of SCORE; ORAI; and Age, Body Size, No Estrogen (ABONE) were very high. No optimal osteoporosis risk assessment tool is available for identifying low BMD and MOF risk.

Pre-screening young postmenopausal women for BMD testing.

Pre-screening young postmenopausal women for BMD testing.

A randomized trial of a mailed intervention and self-scheduling to improve osteoporosis screening in postmenopausal women

Guidelines recommend bone density screening with dual-energy X-ray absorptiometry (DXA) in women 65 years or older, but <30% of eligible women undergo DXA testing. There is a need to identify a systematic, effective, and generalizable way to improve osteoporosis screening. A group randomized, controlled trial of women ≥65 years old with no DXA in the past 4 years, randomized to receive intervention materials (patient osteoporosis brochure and a letter explaining how to self-schedule a DXA scan) versus usual care (control) was undertaken. Outcome of interest was DXA completion. Of 2997 women meeting inclusion criteria, 977 were randomized to the intervention group. A total of 17.3% of women in the intervention group completed a DXA, compared to 5.2% in the control group (12.1% difference, p < 0.0001). When including only those medically appropriate, we found a difference of 19% between the two groups (p < 0.0001). DXA receipt was greater in main clinic patients compared to satellite clinic patients (20.9% main clinic versus 10.1% satellite clinic). The cost to print and mail the intervention was $0.79 per patient, per mailing. The number of women to whom intervention needed to be mailed to yield one extra DXA performed was 9, at a cost of $7.11. DXA scan completion was significantly improved through use of a mailed osteoporosis brochure and the availability for patients to self-schedule. This simple approach may be an effective component of a multifaceted quality improvement program to increase rates of osteoporosis screening.

Osteoporosis screening in postmenopausal women: how and when?

Osteoporosis screening in postmenopausal women: how and when?

Epidemiology of osteoporosis-related fractures in France: A literature review

ObjectivesTo evaluate the health implications and economic burden on society of osteoporotic fractures as a major source of morbidity and mortality in the ageing population. MethodsWe have summarised the findings of a literature review of French studies published between 1960 and 2009, characterised the epidemiology of osteoporosis and osteoporotic fractures, and predicted future trends. ResultsPublished data for France supported the observation that osteoporosis is under-diagnosed in many countries. The incidence of fracture increased exponentially with age, alongside a concurrent decrease in bone mineral density, a risk factor for fracture. Combined with a projected rise in the French elderly population, this poses a significant burden for the future. The incidence of fracture was high in the osteopenic population; consequently, fragility fractures may be underestimated if reports focus on osteoporotic women only. As in many other countries, French data revealed that women have a higher incidence of osteoporotic fractures than men, although mortality from hip fracture was higher in men. DiscussionDue to ageing of the population, an increase in the number of people suffering from fractures is predicted over the next few decades unless preventative action is taken, highlighting the need for improved diagnosis and screening in postmenopausal women.