Screening Tool For Osteoporosis Research Articles

The implication of assessing a polymorphism in estrogen receptor alpha gene in the risk assessment of osteoporosis using a screening tool for osteoporosis in Asians.

Both genetic and environmental factors interact to determine bone mass and the risk for developing postmenopausal osteoporosis. Recently, an Asian-specific tool, the Osteoporosis Self-Assessment Tool for Asians (OSTA), has been developed to assess the risk of osteoporosis in women. An index is calculated by multiplying the difference in body weight in kilograms and age in years by 0.2 and disregarding the decimal digits. The risk of osteoporosis is classified as high, intermediate or low according to the OSTA index less than -4, -4 to -1 and greater than -1. In the present study we examined how a single nucleotide polymorphism (SNP) in exon 8 of the estrogen receptor alpha (ERalpha) gene affected the predictive value of the OSTA index. Subjects consisted of 358 postmenopausal women who were at least 55 years old. BMDs were measured by DXA, and the SNP in the ERalpha gene was assessed by PCR-RFLP. When considering both the OSTA index and ERalpha genotype in a logistic regression model, it was found that both the OSTA index and the ERalpha genotype independently contributed to the risk of osteoporosis. The odds ratios were 1.58 (95% CI 1.26-1.91) and 2.51 (95% CI 1.42-4.44) for one unit decrement in the OSTA index and each copy of the A allele of the ERalpha genotype, respectively. The joint effect conformed more to a multiplicative model of interaction than an additive model. This suggests that persons with the high-risk genotype are at far greater risk of developing osteoporosis with advancing age or decreasing body weight, the two variables from which the OSTA index is derived. Targeting preventive measures for osteoporosis subjects with risk factors and also disease-susceptibility alleles is likely to be more cost effective.

Evaluation of Calcaneal Quantitative Ultrasound in a Primary Care Setting as a Screening Tool for Osteoporosis in Postmenopausal Women

Screening of osteoporosis by quantitative ultrasound (QUS) has become widely available in Europe, but no clear strategies for its clinical use have been established. The aim of this study was to validate the use of QUS in a cross-sectional study carried out in three primary care centers. Measurements of calcaneal QUS and bone mineral density (BMD) at proximal femur were obtained by dual-energy X-ray absorptiometry (DXA). Osteoporosis was diagnosed by DXA T-score <or= -2.5 at the femoral neck. Sensitivity, specificity, kappa index, and receives operator characteristics (ROC) curve QUS values were calculated with respect to the standard reference. Both positive and negative likelihood ratios (LR) were used to calculate the optimum cut-off levels. Two hundred and sixty-seven women aged 65 or older were included. Fifty-five percent had osteoporotic femoral neck BMD values (T-score <or= -2.5). The same threshold for QUS yielded a lower prevalence of osteoporosis (10%). Women with BMD diagnosis of osteoporosis were older and showed lower age-adjusted values for all QUS parameters (p < 0.001). Area under the curve (AUC) ranged from 0.662-0.678 for the different QUS parameters; correlation and concordance of all parameters with femoral neck BMD were statistically significant (p < 0.001). Cut-off values calculated from the AUC yielded 61.1% sensitivity and 65.3% specificity for the best QUS parameter (i.e., Estimated Heel T-score <or= -1.55). Estimated Heel T-score values of +0.05 or above ruled out osteoporosis (LR 0.18), whereas those -2.50 or below supported the diagnosis (LR 5.98). The application of these cutoff points allowed classification of 22.1% of cases. In conclusion, in postmenopausal women, QUS screening conclusively confirms or rules out osteoporosis in approximately one-fifth of cases, thereby avoiding the need for a DXA measurement.

Performance of the Osteoporosis Self-assessment Screening Tool for Osteoporosis in American Men

To determine whether the Osteoporosis Self-assessment Tool (OST) can predict central bone mineral density in men, as defined by dual energy x-ray absorptiometry (DXA). We applied the OST index to men in pulmonary (evaluated January-May 2001) and rheumatology (evaluated November 2001-March 2002) clinics at a veterans hospital. The calculated OST risk index is based on weight and age. In 181 men, we arbitrarily defined osteoporosis as a DXA T score of -25 or less in the spine, total hip, or femoral neck. The mean age and weight of the men were 64.3 years and 91.2 kg; 15.6% had osteoporosis by DXA. The OST index ranged from -5 to 19, from which we categorized risk as follows: low, 4 or greater; moderate,-1 to 3; and high, -2 or less. Only 2.0% of men with a low-risk OST index had osteoporosis, whereas 27.0% with a moderate risk and 72.7% with a high risk had osteoporosis. Using an OST cutoff score of 3, we predicted osteoporosis with a sensitivity of 93% and a specificity of 66%. When patients were studied by age in decades, race, or current glucocorticoid use, the predictive value of the OST was maintained. The OST is an easy method to predict osteoporosis by DXA.

Peripheral Osteoporosis Screening in the Menopausal Woman Using the Calcaneus Heel Ultrasound

Objective: Ultrasound of the calcaneus heel has the potential as a non-invasive, radiation free, highly mobile and inexpensive method for screening for osteoporosis. The objective of this study was to established a database for bone mass in a general population of menopausal women using a heel ultrasound device. Design: This was a retrospective study in which data on bone density was determined in postmenopausal women using a heel ultrasound device. Osteoporosis screening was conducted in 15 selected primary care clinics at representative sites throughout the state of Nebraska during the period of December 1998 to October 1999. Materials and Methods: The Lunar Achilles+ Heel Ultrasonometer, used in this study, combines the ultrasound transmission velocity (speed of sound) and attenuation of ultrasound (broadband ultrasound attenuation) to formulate a “stiffness” value that is used in calculation of a T-Score (i.e. the standard deviation below the young adult bone mass). Data on bone mass were determined by the T-Score value. After obtaining an abbreviated patient history, either the right or left heel was evaluated by the ultrasound. The data obtained were analyzed by descriptive statistics, linear regression, Chi Square analysis and one-way analysis of variance. Results: A total of 586 menopausal women were evaluated with an age range of 33 (surgical) - 93 years of age. Independent of age, general findings indicated that 38.2% (n=224) had a normal bone mass (T-Score = <−1), 44.9% (n=263) were osteopenic (T-Score = −1 to −2.5) and 16.9% (n=99) were osteoporotic (T-Score =>−2.5). When the women were separated into age groups of less than 65 (n=257) or 65 and older (n=322), the results indicated that 54.5% had a normal bone mass, 38.9% were osteopenic and 6.6% were osteoporotic in the <65 age group, whereas in the 65 years or older group, 25.2% were normal, 49.4% were osteopenic and 25.5% were osteoporotic. The difference in the distribution of bone mass between the two age groups was highly significant (P<0.001). In the total population of menopausal women, there was a highly significant correlation (P<0.001) with age and the T-Score (i.e. as age increased the T-Score became more negative). The mean age group was 60.7±.6 years for normal bone mass, 66.3 ± .5 years for those diagnosed with osteopenia, and 72.8 ± .4 years for those diagnosed with osteoporosis (P<0.001). For all age groups, there was a significantly (P<0.001) greater proportion of women with normal bone mass (vs low bone mass) who were taking the combination of estrogen replacement therapy (ERT) and calcium supplementation (Ca) vs those who were taking ERT or Ca alone or neither one. Conclusions: (1) Ultrasound of the calcaneus heel appears to be an excellent screening tool for osteoporosis. (2) The results support other studies indicating that women 65 years or older are at high risk for osteoporosis. (3) ERT without adequate Ca does not appear to be protective against bone loss. This study was supported in part by Merck & Co., Inc.

A New X-Ray Based Osteoporosis Screening Tool Provides Accurate and Precise Assessment of Phalanx Bone Mineral Content

Many devices currently available for the assessment of osteoporosis require a significant capital investment, are not portable, and require specially trained operators. The objective of this study was to assess the accuracy and precision of a new tabletop dual-energy computed digital absorptiometry (CDA) device (accuDEXA, Schick Technologies, Long Island City, NY) designed to automatically and instantaneously assess bone mineral content (BMC) and bone mineral density (BMD) of the middle finger. BMC and BMD of 26 cadaveric forearms were measured by dual-energy X-ray absorptiometry, radiographic absorptiometry (RA), and CDA. accuDEXA measurements were repeated five times with and without repositioning on 10 forearms. The portion of the finger evaluated by accuDEXA was then excised, measurements of the specimen were again obtained using the accuDEXA device, and the specimen was incinerated to determine ash weight. BMC assessed by accuDEXA and by RA were strongly correlated with ash weight of the excised phalanx specimens (r2 = 0.94 and r2 = 0.96, respectively). Short-term precision for BMD assessed by the accuDEXA device was 0.9% without repositioning, and 1.8% with repositioning. BMD determined by the accuDEXA device was strongly correlated with BMD of the hand and forearm (r2 = 0.56-0.69). Dual-energy CDA is a new bone densitometry technique that provides rapid, precise, and accurate measurements of the middle phalanx of the third finger. The technique may be useful for widespread testing of osteoporotic patients.

PHB1 Efficient Strategies for Osteoporosis Testing

There are multiple screening and testing tools for osteoporosis. We need to understand the most cost-efficient way to utilize these tools to identify postmenopausal women with osteoporosis. The objective of this study was to identify efficient strategies for detecting low bone mass in postmenopausal women and estimate the incremental cost per case found. METHODS:The study sample consists of 392 women age >50. Each participant completed the Simple Calculated Osteoporosis Risk Estimation (SCORE*) (a prescreening questionnaire), and bone mineral density (BMD) levels were collected at different skeletal sites. Assumed costs were: $5 for SCORE, $35 for peripheral site (pDXA) testing at the forearm, $120 for single central (DXA) site testing at hip or spine, and $200 for multiple site DXA. An osteoporotic woman was defined as a woman with BMD < −2 SD below peak adult mean at any site. RESULTS:The cost, efficient frontier consisted of 7 strategies ranging in cost from $33 to $189 per patient, with corresponding sensitivity of 53% to 100%. The incremental cost per case found ranged from $62.30 to $1,100. Most importantly, the current gold standard (testing all women at the hip and spine) is not on the efficient frontier. CONCLUSION:The efficiency of osteoporosis testing can be greatly increased through the appropriate use of sequential instruments to identify postmenopausal women with osteoporosis.

The relationship between height change and bone mineral density.

This pilot study was designed to determine if height loss would serve as an effective screening tool for osteoporosis. Height loss, bone density data, and fracture history were obtained from a patient population in a bone health clinic. The 76 subjects ranged from 25 to 88 years of age with mean age 60.4 years. Maximum height was established by the subject's recall and the height recorded on their driver's license. Current height was also assessed. Results indicate that excessive height loss does reflect low bone mass and may predict osteoporosis-related fractures.