Optimal Screening Strategies for Treatment of Osteoporosis and Fractures

Study Looks at Residents Living in Long-term Care Facilities

Caregivers assisting an elderly womanIn a cross-sectional analysis, researchers looked at the screening strategies for treatment of osteoporosis and fractures in residents who live in assisted living or skilled care facilities.

Their results were 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.” The article will appear in an upcoming issue of the Journal of the American Geriatrics Society.

A total of 202 frail women participated in the study. Women were 65 years old or older, and the mean age of the women was 85 years old. The study excluded women who took bisphosphonates.

Researchers used the following measurements in the study:

  • clinical fractures of the hip or spine (Clin Fx)
  • Clin Fx or bone mineral density (BMD)
  • Clin Fx, BMD, or vertebral fractures (VFs) measured using dual-energy x-ray absorptiometry (DXA)-based VF assessments
  • fracture risk algorithm using femoral neck BMD (FRAX-FN)
  • fracture risk algorithm using body mass index (FRAX-BMI)
  • Clin Fx or heel ultrasound

The research team found that osteoporosis treatment eligibility in the women ranged from 17% (Clin Fx) to 98% (FRAX-BMI). Additionally, they found that VFs were present in 47% of the women (74% of theses VFs were silent fractures).

Using Clin Fx, BMD, or VF criteria, researchers identified that 73% of the women were eligible for osteoporosis treatment. In addition, the FRAX-FN findings suggested treatment in 81% of the women; however, these findings would have missed approximately 10% of the women with silent VFs. The Clin Fx or heel ultrasound findings suggested that 39% of the women were eligible for osteoporosis treatment.

The research team concluded that fewer than 20% to almost all long-term care residents—depending on the screening criteria—were eligible for osteoporosis treatment. They found that VFs are common in this population, and these findings pinpoint a group of patients who are often missed by traditional BMD scans or FRAX-FN.

As a result of their findings, the researchers suggest a reasonable clinical approach that considers treatment for women with clinical fractures of the hip or spine, radiological evidence of a vertebral fracture, or osteoporosis (according to BMD classification). They recommend future prospective studies to determine optimal screening strategies for treatment in this population.

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