Make the Diagnosis: Osteoporosis
The prior probability of osteoporosis in women depends on age and ethnicity (Tables 36-12 and 36-13).
Table 36-12Age-Dependent Prevalence of Osteoporosis in White Women |Favorite Table|Download (.pdf) Table 36-12 Age-Dependent Prevalence of Osteoporosis in White Women
|Age, y ||Prevalence, % |
|50-59 ||15 |
|60-69 ||22 |
|70-79 ||39 |
|≥80 ||70 |
Table 36-13Age-Dependent Prevalence in Nonwhite Women |Favorite Table|Download (.pdf) Table 36-13 Age-Dependent Prevalence in Nonwhite Women
|Women > 50 y ||Prevalence, % |
|Non-Hispanic black women ||12 |
|Mexican American women ||19 |
|Other ethnicity ||28 |
Comparable data for men have not been adequately validated.
Population for Whom Osteoporosis Should Be Considered
Age beyond menopause and low BMI (<25) or weight (<60 kg) are the most important predictors of osteoporosis in women. Older age and low BMI might also be the most important factors in men. Any older patient with a minimal trauma fracture or kyphosis should be screened for osteoporosis.
Detecting the Likelihood of Osteoporosis
The SCORE and ORAI questionnaires have the best measurement properties for screening (see Tables 36-14 and 36-15), but the ORAI is a bit easier to use. The OST has not been as extensively validated in women but is one of the few tests with evidence in men.
Table 36-14Osteoporosis Risk Assessment Instrument |Favorite Table|Download (.pdf) Table 36-14 Osteoporosis Risk Assessment Instrument
|Item ||Scoring ||LR (95% CI) |
|Age ||≥ 75 y = 15 Points ||Total score ≥ 9 points, LR = 1.6 (1.4-1.8) |
|65-74 y = 9 Points |
|55-64 y = 5 Points |
|Weight ||< 60 kg = 9 Points ||Total score < 9 points, LR = 0.13 (0.04-0.40) |
|60-69.9 kg = 3 Points |
|No current estrogen use ||2 Points || |
Table 36-15Osteoporosis Self-assessment Tool |Favorite Table|Download (.pdf) Table 36-15 Osteoporosis Self-assessment Tool
|Test ||Abnormal ||LR+ (95% CI) ||LR– (95% CI) |
|Score = 0.2 (body weight [kg] – age [y]), rounded down to nearest integer ||Depends on population; ≤ –1 in Asian men, ≤ 3 in US male veterans ||2.4 (2.0-2.9) ||0.35 (0.23-0.53) |
Bone mineral densitometry with T score values less than or equal to 2.5 SDs below the mean of young, healthy population.
Original Article: Does This Patient Have Osteoporosis?
You recommend screening densitometry to a healthy 64-year-old woman. She will have to drive 1 hour to the nearest testing center, and she does not believe that she needs the test. To further assess her risk, you note that she weighs 49 kg (108 lb). What can you tell this patient about her probability of osteoporosis?
A frail, 79-year-old woman is admitted to the ...