Osteoporosis International

, Volume 2, Issue 1, pp 48–53 | Cite as

Screening for vertebral osteoporosis using individual risk factors

  • C. Cooper
  • S. Shah
  • D. J. Hand
  • J. Adams
  • J. Compston
  • M. Davie
  • A. Woolf
Original Article


Osteoporosis is a major cause of ill health in postmenopausal women. Several risk factors for osteoporosis have been identified, and they have been widely recommended as a means of identifying subgroups of postmenopausal women who might benefit from prophylaxis and therapy. Evidence to support this use of risk factors is currently lacking, however. We have constructed and evaluated a profile of putative risk factors as a means of identifying women attending general practitioners who have sustained vertebral fractures. The overall prevalence of vertebral fractures in the 1012 women (mean age 64.4 years) studied was 7.8%. Women who had sustained vertebral fractures in this population were significantly (p<0.05) older and shorter than those without fractures. They reported a significantly (p<0.05) earlier menopause, lower parity and a greater prevalence of hyperthyroidism. However, the best screening instrument devised was not sufficiently predictive to warrant widespread use.


Risk factors Screening Vertebral fractures Osteoporosis 


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  1. 1.
    Cooper C. Osteoporosis: an epidemiological perspective. A review. J R Soc Med 1989; 82: 753–7.Google Scholar
  2. 2.
    Melton LJ, Kan SH, Frye MA, Wahner HW, O'Fallon WM, Riggs BL. Epidemiology of vertebral fractures in women. Am J Epidemiol 1989; 129: 1000–11.Google Scholar
  3. 3.
    Consensus Development Conference. Prophylaxis and treatment of osteoporosis. Br Med J 1987; 295: 914–15.Google Scholar
  4. 4.
    Cummings SR, Kelsey JL, Nevitt MC, O'Dowd KJ. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 1985; 7: 178–208.Google Scholar
  5. 5.
    Cooper C, Barker DJP, Wickham C. Physical activity, muscle strength and calcium intake in fracture of the proximal femur. Br Med J 1988; 297: 1443–6.Google Scholar
  6. 6.
    Cooper C, Wickham C. Cigarette smoking and the risk of agerelated fractures. In: Wald N, Frogatt P, eds. Smoking and hormone related disorders. Oxford University Press, 1990:93–100.Google Scholar
  7. 7.
    Fleiss JL. Statistical methods for rates and proportions. New York: Wiley, 1981:212–36.Google Scholar
  8. 8.
    Hand DJ. Discrimination and classification. Chichester: Wiley, 1981.Google Scholar
  9. 9.
    Hand DJ. Recent advances in error rate estimation. Pattern Recognition Lett 1986; 4: 335–6.Google Scholar
  10. 10.
    Jensen GF, Christiansen C, Boesen J, Hegedus V, Transbøl I. Epidemiology of postmenopausal spinal and long bone fractures: a unifying approach to postmenopausal osteoporosis. Clin Orthop 1982; 166: 75–81.Google Scholar
  11. 11.
    Eastell R, Cedel SL, Wahner HW, Riggs BL, Melton LJ. Classification of vertebral fractures. J Bone Miner Res 1991; 6: 207–15.Google Scholar
  12. 12.
    Smith-Bindman R, Cummings SR, Steiger P, Genant HK. A comparison of morphometric definitions of vertebral fracture. J Bone Miner Res 1991; 6: 25–34.Google Scholar
  13. 13.
    Hedlund LR, Gallagher JC. Vertebral morphometry in diagnosis of spinal fractures. Bone Miner 1988; 5: 59–67.Google Scholar
  14. 14.
    Hayes WC, Piazza SJ, Zysset PK. Biomechanics of fracture risk prediction of the hip and spine by quantitative computed tomography. Radiol Clin North Am 1991; 29: 1–18.Google Scholar
  15. 15.
    Aloia JF, Cohn SH, Vaswani A, Yeh JK, Yuen K, Ellis K. Risk factors for postmenopausal osteoporosis. Am J Med 1985; 78: 95–100.Google Scholar
  16. 16.
    Seeman E, Melton LJ, O'Fallon WM, Riggs BL. Risk factors for spinal osteoporosis in men. Am J Med 1983; 75: 977–83.Google Scholar
  17. 17.
    Riggs BL, Melton LJ. Involutional osteoporosis. N Engl J Med 1986; 314: 1676–86.Google Scholar
  18. 18.
    Elders PJM, Netelenbos JC, Lips P, Khoe E, van Ginkel FC, Hulshof KFAM, van der Stelt PF. Perimenopausal bone mass and risk factors. Bone Miner 1989; 7: 289–99.Google Scholar
  19. 19.
    Slemenda CW, Hui SL, Longcope C, Wellman H, Johnston CC. Predictors of bone mass in perimenopausal women. A prospective study of clincial data using photon absorptionmetry. Ann Intern Med 1990; 112: 96–101.Google Scholar
  20. 20.
    Wasnich RD, Ross PD, Maclean CJ, Davis JW, Vogel JM. The relative strengths of osteoporotic risk factors in a prospective study of postmenopausal osteoporosis. In: Christiansen C, Johansen JS, Riis BJ, eds. Osteoporosis 1. Proceedings of the International Symposium on Osteoporosis, Denmark, 1987. Copenhagen: Osteopress ApS, 1987:394–7.Google Scholar
  21. 21.
    Kleerekoper M, Peterson E, Nelson D, Tilley B, Phillips E, Schork MA, Kuder J. Identification of women at risk for developing postmenopausal osteoporosis with vertebral fractures: role of history and single photon absorptiometry. Bone Miner 1989; 7: 171–86.Google Scholar

Copyright information

© European Foundation for Osteoporosis 1991

Authors and Affiliations

  • C. Cooper
    • 1
  • S. Shah
    • 2
  • D. J. Hand
    • 3
  • J. Adams
    • 4
  • J. Compston
    • 5
  • M. Davie
    • 6
  • A. Woolf
    • 7
  1. 1.Rheumatology UnitBristol Royal InfirmaryUK
  2. 2.Medical Department, Sandoz PharmaceuticalsUK
  3. 3.Faculty of MathematicsThe Open UniversityMilton Keynes
  4. 4.Department of Diagnostic RadiologyUniversity of Manchester Medical SchoolUK
  5. 5.Department of MedicineUniversity of Cambridge Medical SchoolUK
  6. 6.Robert Jones and Agnes Hunt Orthopaedic HospitalOswestry
  7. 7.Royal Cornwall Hospital (City)TruroUK

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