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


CLINICAL QUESTION
QUESTION CLINIQUE
 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
RÉSULTAT FINAL
 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
DONNÉES PROBANTES
 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 white 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)
Auteur(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.

Les auteurs n’ont aucun conflit d’intérêts à déclarer.