A comparison of different screening strategies to identify elderly women at high risk of hip fracture: results from the EPIDOS prospective study

Abstract

Decision to treat with an anti-osteoporotic drug should be based on individual fracture risk evaluation. We compared the discriminant value of four different screening strategies to identify elderly women with a risk of hip fracture greater than 20 per 1000 woman-years: (1) BMD screening alone, (2) quantitative ultrasound (QUS) screening alone, (3) QUS triage followed by BMD assessment for women with medium-low QUS parameters, and (4) selective BMD screening based on weight followed by clinical evaluation for women with medium-low BMD. The study population included 5910 women aged 75 years or older who participated to the EPIDOS (Epidemiologie de l'Ostéoporose) prospective study. Over an average of 3.7 (+/-0.8) years of follow-up, 231 women suffered a hip fracture, which corresponds to an average risk of 10.6 per 1000 woman-years. All strategies allow us to clearly distinguish a group at high risk of hip fracture (i.e. >20 per 1000 woman-years) from a group at low risk (i.e. below the average risk in the cohort). QUS screening alone has a very low sensitivity (15%). The strategy using QUS as a method of triage and that combining selective BMD and clinical assessment have a sensitivity equivalent to systematic BMD screening (around 35%), with less than 50% BMD examinations. The high-risk women identified by these two strategies are not the same. A simple algorithm combining QUS, BMD, and clinical risk assessment allows an increased number of high-risk women to be identified (21%), and thus improves the sensitivity (53%). With this combined strategy, women in the high-risk group have one chance in ten of having a hip fracture over the next 4 years, whereas women in the low risk group have only one chance in 40.

The ability of peripheral quantitative ultrasound to identify patients with low bone mineral density in the hip or spine

“…Three previous studies (Frost et al 2000;Damilakis et al 2001;Dargent-Molina et al 2003) have utilized QUS of the calcaneus as an investigation to differentiate between those people requiring further investigation using BUA and those classified as normal. The first study recommends a T-score cut-off of Ϫ2 for BUA, in agreement with this study and the manufacturers' recommendation.…”

Prescreening for Osteoporosis With Quantitative Ultrasound in Postmenopausal White Women

“…Compared to DXA, which is center bound and emits low doses of ionizing radiation, QUS is transportable, inexpensive, time saving, and radiation free . Previous studies suggested that QUS of the calcaneus could be used as a prescreening tool to identify patients at high risk, for whom treatment should be initiated, just as it could limit the number of patients who need a DXA measurement by predicting patients at very low risk . As a result of differing measurement techniques and skeletal sites, cutoff values vary between different QUS devices.…”

Risk assessment tools to identify women with increased risk of osteoporotic fracture: Complexity or simplicity? A systematic review

“…We identified three studies evaluating the use of risk assessment tools in clinical practice in a randomized design …”