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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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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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