A triage strategy based on clinical risk factors for selecting elderly women for treatment or bone densitometry: the EPIDOS prospective study

Abstract

A triage strategy, based on a clinical hip fracture risk score, may be used to classify elderly women into three groups: one at high risk and requiring treatment, another needing further assessment by bone densitometry, and a third at low risk. We used prospective data from the EPIDOS study (7512 women older than 75 years and followed for an average of 3.9 years) to assess the potential value of such a strategy for identifying elderly women with a hip fracture risk twice the cohort average (i.e. > or =20 per 1000 woman-years). An individual fracture risk score was calculated with the final risk function (Cox model). To compare this strategy with systematic BMD measurement and with current European recommendations, we examined the number of high-risk women identified, their average risk levels, sensitivity for hip fracture, and the number of high-risk women who need to be treated to prevent one hip fracture (hypotheses: all identified women are treated; sensitivity is equal to the point estimate; treatment reduces fracture risk by 35%). A triage strategy based on age, fracture history since the age of 40 years, body mass index, number of instrumental activities of daily living for which assistance is needed, grip strength, and visual acuity can identify 20% of the cohort as at high risk, 75% of them from clinical factors only, and the rest after BMD measurements (threshold: -2.5 T-score). The triage strategy would be significantly more sensitive than systematic BMD screening (51 versus 35%) and would require many fewer BMD examinations (10%). Compared with current recommendations, triage would identify fewer women (20 versus 28%) but at a significantly higher average risk of hip fracture (30 versus 20 per 1000 woman-years). Fewer high-risk women would be treated to prevent one hip fracture (29 versus 41) and fewer bone densitometry tests would be needed (10% versus 54%). The proposed triage strategy may be a useful clinical tool for selecting elderly women for treatment or bone densitometry.

Development of a prediction tool for low bone mass based on clinical data and periapical radiography

“…Age is considered to be one of the most important clinical risk factors for osteoporosis. 5,8 In this study the lamina dura and periodontal ligament were avoided during the selection of the ROI, although a recent study stated that there is no difference in the results when they are included. 28 Several authors have used self-administered questionnaires for assessment of osteoporosis based entirely on clinical risk factors.…”

“…4 Consequently, women are usually selected for bone densitometry based on clinical risk factors such as age, fracture history since menopause, low bone mass index and long-term corticosteroid use. [5][6][7][8][9][10][11][12] It is well known that osteoporosis results in the alteration of the mandibular structures, especially the mandibular cortex. [13][14][15][16][17][18][19][20][21][22][23] Recent studies have linked osteoporosis to alterations of the trabecular bone, visible in dental radiographs.…”

The Relationship of Osteoporosis Risk Factors with Bone Mineral Density in Patients Admitted Our Outpatient Clinic in Trabzon

“…In a large cohort, a total of 7.512 women older than 75 years which were followed for an average of 3.9 years in the prospective epidemiology of OP study. This study revealed that fracture history since the age of 40 years was one of the most valuable predictors of hip fracture (20). Although in some studies delayed menarche, premature menopause, and short reproductive period were reported as possible risk factors, other studies found no association (21)(22)(23)(24)(25).…”

EMAS position statement: Bone densitometry screening for osteoporosis

“…One approach is to select individuals older than 65 years. The rationale is that there is an exponential rise in the risk of fractures with age [22], and older individuals may be more amenable to treatment. The major advantage of screening in later life is to increase the proportion of individuals identified who will sustain fractures and be targeted for treatment.…”