Pre-screening of high-risk patients for osteoporosis in primary healthcare

Zoltán Lakó-Futó, Andrea Kiszely, Krisztián Vörös

Keywords: osteoporosis, FRAX, DEXA

Background:

Osteoporosis (OP) and resulting fractures are associated with increased mortality. Each year OP leads to nearly 9 million fractures, and by 2040, more than 319 million people are projected to be at high risk of osteoporosis-related fractures, worldwide.

Research questions:

Aim: determine the feasibility of using the FRAX score in women who would not be screened based on their age.

Method:

Female patients aged 55-65 (n = 98) of a suburban GP practice in Budapest, Hungary were enrolled in August 2022. After recording demographic, anthropometric, and anamnestic data, we calculated the FRAX score. Finally, we performed bone density measurement using an Osteometer DTX-200 device. (MediTech 2747 Signal Parkway, CA 90755, USA)

Results:

The BMD measurements and the score calculated by FRAX were compared. The BMD significantly correlated with the FRAX score for hip fracture (r = -0.490, p < 0.001) and for overall fracture risk (r = 0.505, p < 0.001). Patients with abnormal FRAX score had significantly lower BMD (-2.56 ± 0.59 vs -0.77 ± 1.26 g/cm2 p < 0.001, Mann-Whitney U test). In multivariate analysis having bone fracture in the history (p = 0.049) and lower BMI (p < 0.001) were independent determinants of BMD.
Of the 98 patients, 25 had osteopenia (25.5%), and 11 had osteoporosis (11.2%). Eight patients (8.3%) had an abnormal FRAX score. Based on the measured BMD, six of the eight patients had osteoporosis, one had osteopenia and only one patient had normal bone density. Abnormal FRAX score had a 19.4% sensitivity and a 98.3% specificity for osteoporosis and osteopenia.

Conclusions:

Osteoporosis and osteopenia are common in women younger than the recommended age threshold for screening. The FRAX score has low sensitivity, but excellent specificity for identifying these conditions. Women younger than 65, who have bone fractures, have lower BMI and abnormal FRAX score should undergo bone density measurement.

Points for discussion:

Frax score

Pre screening of osteoporosis

High risk patients for osteoporosis

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