What Are Optimal Screening Strategies for Treatment of Osteoporosis and Fractures of the Spine?
Researchers Examine Residents in Long-term Care Facilities
Recently, researchers designed a cross-sectional analysis to examine screening strategies for the treatment of osteoporosis and fractures—specifically fractures in the spine and hip—for residents living in long-term care facilities.
The study was published online in February 2012 in the article “FRAX or fiction: determining optimal screening strategies for treatment of osteoporosis in residents in long-term care facilities.” It will appear in an upcoming edition of the Journal of the American Geriatrics Society.
There were 202 frail women involved in the study. These women were 65 years old or older; their mean age was 85 years old. Women taking bisphosphonates were excluded from the study.
Measurements researchers used in the study included:
- clinical fractures of the hip or spine (Clin Fx)
- Clin Fx or bone mineral density (BMD)
- Clin Fx or heel ultrasound
- Clin Fx, BMD, or vertebral fractures (VFs), which were measured according to dual-energy x-ray absorptiometry (DXA)-based assessments of VFs
- fracture risk algorithm using body mass index (FRAX-BMI)
- fracture risk algorithm using femoral neck BMD (FRAX-FN)
The osteoporosis treatment eligibility for the women ranged from 17% (Clin Fx) to 98% (FRAX-BMI). Researchers found that 47% of the women had VFs, and 74% of the VFs were silent.
They also found that the Clin Fx, BMD, or VF criteria showed that 73% of the women were qualified for treatment. The FRAX-FN results suggested treatment in 81% of the women, but it would have missed approximately 10% of the participants who had silent VFs. In addition, researchers found that the Clin Fx or heel ultrasound findings suggested that 39% of the women were eligible for treatment.
At the end of the study, researchers concluded that long-term care residents who were eligible for osteoporosis treatment ranged from fewer than 20% to roughly all of the residents. They noted that who was eligible depended on screening criteria. According to their findings, VFs are common, which leads the researchers to believe that an osteoporosis or fracture diagnosis in this group may be missed by using FRAX-FN or conventional BMD scans.
The research team suggests using a practical clinical approach that considers treatment for patients who have clinical fractures of the hip or spine, radiological evidence of a vertebral fracture, or osteoporosis according to BMD classification. They suggest prospective studies to establish the optimal screening strategies for treatment of osteoporosis and fractures in this population.