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Targeted assessment of fracture risk in women at midlife

Osteoporosis International volume 26, pages 1705–1712 (2015)Cite this article

Abstract

Summary

This study establishes a profile for women at midlife, referred for a dual energy X-ray absorptiometry (DXA), most likely to have osteoporosis, and from this, a pre-DXA screening tool has been developed. These findings inform much needed evidence-based guidelines for targeted and effective screening for osteoporosis and osteoporotic fracture prevention in women at midlife.

Introduction

There is no consensus as to whether women at midlife should undergo screening dual energy X-ray absorptiometry (DXA) to identify osteoporosis (T-score < −2.5).

Methods

We investigated the prevalence of osteoporosis in women, aged 40–65 years, referred to 42 community-based Australian radiology centres, and identified the characteristics that best predict osteoporosis in women having a screening DXA.

Results

One thousand four hundred and two women completed the study questionnaire and had DXA reports available. After excluding women with an established indication for a DXA (58 %), users of bone-specific medication (10.5 %) and cancer (7.6 %), 466 women were classified as having a screening DXA. Forty of these women had osteoporosis at the lumbar spine (n = 32, 6.9 %) or femoral neck (n = 17, 3.6 %). Three predictors of osteoporosis (postmenopausal, nonuse of hormonal therapy and body mass index) were identified and incorporated into the Monash Osteoporosis Risk Score for women at midlife (MORS). In the screened study population, the MORS had a sensitivity of 70 % and specificity of 66 %, with a positive predictive value of 16.2 % and negative predictive value of 95.9 % for osteoporosis.

Conclusions

Very few women referred for a screening DXA scan will be found to have osteoporosis. The MORS, a simple decision tool, would have identified 70 % of the women in our screening DXA study population and would have eliminated over 60 % of the screening DXA studies. Hence, use of the MORS may reduce unnecessary DXA scans and facilitate identification of the majority of cases of osteoporosis in women aged 40 to 65 years.

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References

  1. US Preventive Services Task Force (2002) Screening for osteoporosis in postmenopausal women. Ann Intern Med 137:526–528

    Article  Google Scholar 

  2. Hawker G, Mendel A, Lam MA, Akhavan PS, Cancino-Romero J, Waugh E, Jamal S, Mian S, Jaglal S (2012) A clinical decision rule to enhance targeted bone mineral density testing in healthy mid-life women. Osteoporos Int 23:1931–1938

    CAS  PubMed  Article  Google Scholar 

  3. Cadarette SM, Jaglal SB, Murray TM, McIsaac WJ, Joseph L, Brown JP (2001) Evaluation of decision rules for referring women for bone densitometry by dual-energy x-ray absorptiometry. JAMA 286:57–63

    CAS  PubMed  Article  Google Scholar 

  4. Crandall CJ, Larson J, Gourlay ML et al (2014) Osteoporosis screening in postmenopausal women 50 to 64 years old: comparison of US preventive services task force strategy and two traditional strategies in the women’s health initiative. J Bone Miner Res 29:1661–1666

    PubMed  Article  Google Scholar 

  5. Gourlay ML, Miller WC, Richy F, Garrett JM, Hanson LC, Reginster JY (2005) Performance of osteoporosis risk assessment tools in postmenopausal women aged 45–64 years. Osteoporos Int 16:921–927

    PubMed  Article  Google Scholar 

  6. Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E (2008) FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19:385–397

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  7. Cadarette SM, Jaglal SB, Kreiger N, McIsaac WJ, Darlington GA, Tu JV (2000) Development and validation of the osteoporosis risk assessment instrument to facilitate selection of women for bone densitometry. CMAJ 162:1289–1294

    CAS  PubMed Central  PubMed  Google Scholar 

  8. Finkelstein JS, Brockwell SE, Mehta V et al (2008) Bone mineral density changes during the menopause transition in a multiethnic cohort of women. J Clin Endocrinol Metab 93:861–868

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  9. Management of osteoporosis in postmenopausal women (2010) 2010 position statement of The North American Menopause Society. Menopause 17:25–54

    Article  Google Scholar 

  10. Papaioannou A, Morin S, Cheung AM et al (2010) 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 182:1864–1873

    PubMed Central  PubMed  Article  Google Scholar 

  11. Bell RJ, Lijovic M, Fradkin P, Davis SR (2008) A pragmatic approach to the classification of menopausal status for community-based research. Menopause 15:978–983

    PubMed  Article  Google Scholar 

  12. Jane FM, Davis SR (2014) A practitioner’s toolkit for managing the menopause. Climacteric 1 -16

  13. Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, Sherman S, Sluss PM, de Villiers TJ (2012) Executive summary of the stages of reproductive aging workshop + 10: addressing the unfinished agenda of staging reproductive aging. J Clin Endocrinol Metab 97:1159–1168

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  14. Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ 3rd, Khaltaev N (2008) A reference standard for the description of osteoporosis. Bone 42:467–475

    CAS  PubMed  Article  Google Scholar 

  15. Schousboe JT, Shepherd JA, Bilezikian J, Baim S (2013) Executive summary of the 2013 ISCD position development conference on bone densitometry. J Clin Densitom 16:455–467

    PubMed  Article  Google Scholar 

  16. Medicare Australia (2010) Medicare benefits schedule book. In. Australian government, department of health and ageing, Canberra, pp http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/Downloads-201011

  17. Gourlay ML, Overman RA, Fine JP, et al. (2014) Baseline age and time to major fracture in younger postmenopausal women. Menopause

  18. National Osteoporosis Foundation (2013) Clinician’s guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation, Washington DC

    Google Scholar 

  19. Australian demographic statistics (2011) Australian bureau of statistics, Australia, Dec 2011

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Acknowledgments

We would like to thank the study participants, our study co-ordinators Jenny Adams, Corallee Morrow and Maria LaChina, Jill Yeatman and Julie-Ann Evans who assisted in the retrieval of DXA results, Dr Alain Lavoipierre, Director of Radiology, MDI, and Dr Christian Wriedt, Director of Medical Services, I-Med Australia. We are thankful to the staff of the following radiology centres, who recruited participants to the study: New South Wales, I-Med Regional Imaging Wagga Wagga and West Albury; Northern Territory, I-Med Regional Imaging Casuarina; Queensland, Southern Cross Radiology Carboolture, Gympie, Ipswich and Chermside; Tasmania, I-Med Regional Imaging Launceston and Lenah Valley; Victoria, Bendigo Radiology Bendigo and Hamilton; MIA Berwick, Blackburn, Boronia, Cabrini Malvern, Caulfield, Dandenong, East Ringwood, Frankston, Glen Waverley, Hoppers Crossing, John Fawkner Hospital, Lilydale, Mentone, Monash, Mont Albert and Rosebud; MDI Berwick, Cheltenham, Malvern; Lake Imaging Ballarat, Geelong, Melton and Sunbury; Goulburn Valley Imaging; Focus Imaging Shepparton; FMIG Footscray, Hawthorn, Moonee Ponds and St Albans.

Conflicts of interest

Susan Davis has received an honorarium from Abbott Australia, is a consultant for Trimel Pharmaceuticals and has received research funding support from Lawley Pharmaceuticals. Amanda Tan and Robin Bell declare that they have no conflict of interest.

Funding

This research was supported by a competitive grant from the Amgen/GSK Clinical Grants Program administered by the Osteoporosis Australia-ANZBMS Research Fund.

Susan Davis is an Australian NHMRC Principal Research Fellow (Grant No. 1041853).

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Affiliations

  1. Women’s Health Research Program, School of Public Health and Preventive Medicine, Monash University, Level 6 The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia

    S. R. Davis, A. Tan & R. J. Bell

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  1. S. R. Davis
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  2. A. Tan
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  3. R. J. Bell
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Correspondence to S. R. Davis.

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Davis, S.R., Tan, A. & Bell, R.J. Targeted assessment of fracture risk in women at midlife. Osteoporos Int 26, 1705–1712 (2015). https://doi.org/10.1007/s00198-015-3046-9

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  • DOI: https://doi.org/10.1007/s00198-015-3046-9

Keywords

  • Menopause
  • Osteoporosis
  • Screening bone densitometry