Can doctors accurately determine osteoporosis-related fracture risk without using bone scans?

Bone density tests are typically considered an invaluable tool for the diagnosis of osteoporosis, but new research suggests that physicians may be able to ballpark a patient's risk of hip fracture without resorting to bone scans.

The study appeared in the latest issue of the journal Osteoporosis International. In it, scientists from a number of participating Canadian hospitals described analyzing the records of thousands of men and women who had been admitted to their institutions over the preceding 10 years.

Researchers ultimately determined that a patient's risk of hip fracture is often fairly obvious without a bone mass density scan - especially among women - and that these scans tend to parse the at-risk from the healthy only in cases of moderate skeletal impairment.



The team reached their conclusions as follows.



They began by sifting through the health records of more than 36,000 patients over the age of 50, all of whom had participated in the Manitoba Bone Density Program.

Each volunteer had been assigned a relative likelihood of hip fracture - and by extension, of osteoporosis - based on the risk factors that he or she displayed. These odds were then confirmed through the use of bone scans.

For the new study, Canadian investigators broke down these cases by risk level (high, medium or low) and by whether or not each patient qualified for a skeletal health intervention, based on criteria set by the U.S. National Osteoporosis Foundation (NOF).

Overall, the group determined that bone scans tended to confirm, rather than discover, the existence of low bone density and the risk of hip fracture.

Among patients who had a high risk of fracture - that is, of at least 20 percent - more than 92 percent qualified for interventions prior to any scanning.

For those who displayed few symptoms of osteoporosis, and who had a low risk of fracture (less than 10 percent), the scans tended to merely confirm that these patients did not need NOF-specified interventions.

Only for medium-risk patients did bone scans play a deciding role in the estimation of fracture risk. However, just 29 percent of the cohort was found to be at medium risk.

The team concluded that doctors may be able to estimate a patient's risk of hip fracture before ordering a bone scan.

Of course, such scans are still an essential part of the diagnosis of osteoporosis. The Mayo Clinic states that, due to scanning technology, this progressive disease can be detected long before a person breaks a bone, even when fractures seem unlikely.
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