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 ||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 ||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 ||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 ||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 ...