Prevalence and Predictors of Osteoporosis Risk in Orthopaedic Patients
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Current physician practices are not effective in adequately evaluating and treating patients for osteoporosis. While dual-energy xray absorptiometry is the gold standard in evaluating bone mineral density, calcaneal quantitative ultrasound has emerged as a low-risk and low-cost alternative.
We estimated the prevalence of abnormal bone mineral density with calcaneal quantitative ultrasound and developed criteria for risk stratification in female and male orthopaedic patients.
We enrolled 500 patients (331 women, 169 men) with a mean age of 67 years (range, 55–94 years) and screened them for osteoporosis with calcaneal quantitative ultrasound. Multivariate logistic regression was used to identify predictors of low bone mineral density and a risk model was developed.
Quantitative ultrasound identified 154 patients with low bone mineral density at the time of enrollment. The prevalence of abnormal bone mineral density was 31% (women: 38%, men: 17%). Multivariate analysis demonstrated age, female gender, smoking, wrist fracture, and spinal deformities independently predicted low bone mineral density. The probability of low bone mineral density among patients with more than one risk factor was greater than 50% among women and greater than 30% among men.
Low bone mineral density is common among orthopaedic outpatients. Age, female gender, smoking, wrist fractures, and spinal deformities are independent risk factors for osteoporosis. We present a probability model designed to assist orthopaedic surgeons in identifying high-risk patients and initiating adequate preventative measures.
Level of Evidence
Level I, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
- 2.Bauer DC, Gluer CC, Cauley JA, Vogt TM, Ensrud KE, Genant HK, Black DM. Broadband ultrasound attenuation predicts fractures strongly and independently of densitometry in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med. 1997;157:629–634.CrossRefPubMedGoogle Scholar
- 3.Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA, Cosman F, Lakatos P, Leung PC, Man Z, Mautalen C, Mesenbrink P, Hu H, Caminis J, Tong K, Rosario-Jansen T, Krasnow J, Hue TF, Sellmeyer D, Eriksen EF, Cummings SR. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med. 2007;356:1809–1822.CrossRefPubMedGoogle Scholar
- 4.Centers for Medicare and Medicaid Services Web site. Available at: http://www.cms.hhs.gov/PFSlookup/02_PFSSearch.asp#TopOfPage. Accessed September 8, 2009.
- 8.Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, Christiansen C, Delmas PD, Zanchetta JR, Stakkestad J, Gluer CC, Krueger K, Cohen FJ, Eckert S, Ensrud KE, Avioli LV, Lips P, Cummings SR. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA. 1999;282:637–645.CrossRefPubMedGoogle Scholar
- 10.GE Healthcare Web site. Lunar Achilles Express. Available at: https://www2.gehealthcare.com/portal/site/usen/menuitem.e8b305b80b84c1b4d6354a1074c84130/?vgnextoid=433f720dc3240210VgnVCM10000024dd1403RCRD&productid=333f720dc3240210VgnVCM10000024dd1403. Accessed September 8, 2009.
- 14.Harris ST, Watts NB, Genant HK, McKeever CD, Hangartner T, Keller M, Chesnut CH III, Brown J, Eriksen EF, Hoseyni MS, Axelrod DW, Miller PD. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy with Risedronate Therapy (VERT) Group. JAMA. 1999;282:1344–1352.CrossRefPubMedGoogle Scholar
- 17.Kanis JA. Risk stratification. In: Cooper C, Gehlbach SH, Lindsay R, eds. Prevention and Treatment of Osteoporosis. London, UK: Informa; 2005:43–56.Google Scholar
- 19.Katz MH. Multivariable Analysis: A Practical Guide for Clinicians. 2nd ed. Cambridge, UK: Cambridge University Press; 2006:96–116.Google Scholar
- 23.The National Health and Nutrition Examination Survey. Available at: http://www.cdc.gov/nchs/nhanes.htm. Accessed September 9, 2009.
- 24.National Osteoporosis Foundation. Available at: http://www.nof.org. Accessed September 9, 2009.
- 25.Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, Hodsman AB, Eriksen EF, Ish-Shalom S, Genant HK, Wang O, Mitlak BH. Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001;344:1434–1441.CrossRefPubMedGoogle Scholar
- 26.Reginster J, Deroisy R, Lecart M, Sarlet N, Zegels B, Jupsin I, Longueville M, Franchimont P. A double-blind, placebo-controlled, dose-finding trial of intermittent nasal salmon calcitonin for prevention of postmenopausal lumbar spine bone loss. Am J Med. 1995;98:452–458.CrossRefPubMedGoogle Scholar
- 31.Stone KL, Seeley DG, Lui LY, Cauley JA, Ensrud K, Browner WS, Nevitt MC, Cummings SR; Osteoporotic Fractures Research Group. BMD at multiple sites and risk of fracture of multiple types: long-term results from the Study of Osteoporotic Fractures. J Bone Miner Res. 2003;18:1947–1954.CrossRefPubMedGoogle Scholar
- 33.Trimpou P, Bosaeus I, Bengtsson BA, Landin-Wilhelmsen K. High correlation between quantitative ultrasound and DXA during 7 years of follow-up. Eur J Radiol. 2009 January 7 [Epub ahead of print].Google Scholar
- 35.Wainwright SA, Marshall LM, Ensrud KE, Cauley JA, Black DM, Hillier TA, Hochberg MC, Vogt MT, Orwoll ES; Study of Osteoporotic Fractures Research Group. Hip fracture in women without osteoporosis. J Clin Endocrinol Metab. 2005;90:2787–2793.Google Scholar