Tools for Practice


#44 Screening for Osteoporosis – Who Should Receive Bone Mineral Density Testing?


CLINICAL QUESTION
What is the most efficient way to determine which patients are at high risk of osteoporosis and require further testing [Bone Mineral Density (BMD)]?

BOTTOM LINE
The Osteoporosis Self-Assessment Tool (OST) is simple, quick, and predicts osteoporosis as reliably as other more complicated instruments. It is a reasonable screening tool to identify those who would benefit from BMD testing.


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EVIDENCE
Study of 860 postmenopausal Asian women examined 11 risk factors to predict osteoporosis:1   
  • Multiple risk factors had minimal value over age and weight alone.  
  • The OST based on weight and age was developed.  
Eight systematic reviews 2007-2015, with up to 108 studies and 208,738 patients evaluated over nine tools to assess the risk of osteoporosis and/or fractures:2-9 
  • OST performs at least as well as others.2-9 For example: 
    • OST performs moderately well identifying femoral neck osteoporosis (sensitivity 89%, specificity 41%) in postmenopausal Caucasian females.9  
  • Tools with fewer risk factors (like OST) predict osteoporosis as well as or better than those with more risk factors.3,4,7-9   
    • No tool was clearly superior.3,4,8 
  • Unlike other tools to assess the risk of osteoporosis, OST has been validated in both sexes and a variety of races.6,9   
  • There were a number of methodological limitations of included studies.2-9 
  • Recent reviews advocate for simple tools like OST.7-9 
Context: 
  • 2010 Osteoporosis Canada guidelines recommend detailed history and focused physical examination for all patients 50-64 years, including assessment of 10 different risk factors for osteoporosis.10 
  • Time required to fully satisfy preventive recommendations is prohibitive. 
    • For example, physicians need 7.4 hours per working day for the provision of preventive services alone.11 
  • Multiple sites offer on-line or printable tables to apply OST.12-15    
  • Simple application of OST: Weight (kg) – Age (years). 
    • If <10, increased risk of osteoporosis and BMD is warranted. 
    • For example: A 55 year old woman weighing 70 kg has an OST=70-55=15,  
      • She is low risk for osteoporosis and does not need a BMD. 

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Author(s):

  • Christina Korownyk MD CCFP
  • G. Michael Allan MD CCFP

1. Koh LK, Sedrine WB, Torralba TP, et al. Osteoporos Int. 2001; 12:699-705.

2. Rud B, Hilden J, Hyldstrup L, et al. Osteoporos Int. 2007; 18:1177-87.

3. Nelson HD, Haney EM, Chou R, et al. Screening for Osteoporosis: Systematic Review to Update the 2002 U.S. Preventive Services Task Force Recommendation [Internet]. Evidence Syntheses, No. 77. Nelson HD, Haney EM, Chou R, et al. Rockville (MD): Agency for Healthcare Research and Quality (US); 2010 Jul.

4. Nelson HD, Haney EM, Dana T, et al. Ann Intern Med. 2010; 153:99-111.

5. Rud B, Hilden J, Hyldstrup L, et al. Osteoporos Int. 2009; 20:599-607.

6. Lim LS, Hoeksema LJ, Sherin K. Am J Prev Med. 2009; 36(4):366-75.

7. McLeod KM, Johnson CS. Geriatr Nurs. 2009; 30:164-73.

8. Rubin KH, Friis-Holmberg T, Hermann AP, et al. J Bone Miner Res. 2013; 28:1701-17.

9. Nayak S, Edwards DL, Saleh AA, et al. Osteoporos Int. 2015 [epub ahead of print]. DOI 10.1007/s00198-015-3025-1

10. Papaioannou A, Morin S, Cheung AM, et al. CMAJ. 2010; 182(17):1864-73.

11. Yarnall KSH, Pollack KI, Ostbye T, et al. Am J Public Health. 2003; 93(4):635-41.

12. See Figure 10-2. U.S. Department of Health and Human Services. Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Office of the Surgeon General, 2004.

13. Medscape. Osteoporosis Self-Assessment Tool for Men. http://reference.medscape.com/calculator/osteoporosis-self-assessment-men. Accessed April 13, 2015.

14. Medscape. Osteoporosis Self-Assessment Tool for Women. http://reference.medscape.com/calculator/osteoporosis-self-assessment-women. Accessed April 13, 2015.

15. University of Washington. OST (Osteoporosis Self-Assessment Tool). http://depts.washington.edu/osteoed/tools.php?type=ost. Accessed April 13, 2015.

Authors do not have any conflicts of interest to declare.