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Osteoporosis

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
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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
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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
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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

Abbreviations: CI, confidence interval; LR, likelihood ratio.

Table 36-15Osteoporosis Self-assessment Tool
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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)

Abbreviations: CI, confidence interval; LR+, positive likelihood ratio; LR–, negative likelihood ratio.

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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