Simple tool facilitates targeted osteoporosis screening
MedWire News: Australian researchers have developed a simple prediction tool that can be used in primary care to facilitate targeted radiological investigation for osteoporosis in older women.
The tool is based on three easily collected variables: rib-pelvis distance, past or current use of hormone therapy for more than 6 months, and body mass index (BMI).
"Identification of women most likely to have osteoporosis may enable primary care physicians to persuade such women to attend for screening," remark Susan Davis (Monash University, Prahran, Victoria, Australia) and colleagues who developed the method as part of the Prospective Screening for Osteoporosis; Australian Primary Care Evaluation of Clinical Tests (PROSPECT) study.
Their aim was to create a simple prescreening tool that identifies women most likely to have osteoporosis and/or a vertebral fracture if sent for radiological screening (dual energy X-ray absorptiometry [DXA] combined with plain X-ray), and therefore most likely to benefit from treatment to reduce fracture risk.
They recruited 2466 women aged 70 years and older who had no previous diagnosis of osteoporosis. Of the women, 21.8% had osteoporosis at the femoral neck and/or lumbar spine based on DXA, 24.7% had at least one vertebral fracture identified by plain X-ray, and 7.3% had both osteoporosis and vertebral fracture.
The researchers carried out a series of statistical analyses based on patients' demographic and clinical data, which resulted in the three-factor PROSPECT wheel tool.
Selecting "yes" or "no" to a rib-pelvis distance greater than two fingerbreadths and ever use of estrogen for more than 6 months, and adding BMI category (<25, 25-30, >30 kg/m2), gives an estimated probability (0-1) of osteoporosis and/or vertebral fracture being detected if DXA and lateral vertebral x-ray are undertaken.
A probability of 0.25 or below indicates low-risk for osteoporosis, 0.25-0.60 indicates moderate risk, while above 0.60 indicates high-risk.
Only recommending radiological screening to women classified as moderate or high risk for osteoporosis resulted in a 14% reduction in community screening, with 93% of women who needed fracture prevention therapy, based on an osteoporosis diagnosis still being detected.
"Thus, the PROSPECT wheel tool is a novel and clinically useful decision-making aid and, when used in primary care instead of blanket screening, enables targeted and effective screening for osteoporosis," Davis and co-authors conclude in the journal Menopause.
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By Laura Dean