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Make the Diagnosis: Osteoporosis

Prior Probability

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
Table 36-13Age-Dependent Prevalence in Nonwhite Women

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
Table 36-15Osteoporosis Self-assessment Tool

Reference Standard Tests

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?

Clinical Scenarios

Case 1

You recommend screening densitometry to a healthy 64-year-old woman. She will have to drive 1 hour to the ...

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