[Prevalence of osteoporosis assessed by densitometry in the Spanish female population]

Risk factors for osteoporosis and fractures in postmenopausal women between 50 and 65 years of age in a primary care setting in Spain: a questionnaire

INTRODUCTION

Osteoporosis (OP) is a major, highly prevalent health problem and osteoporosis-related fractures account for high morbidity and mortality. Therefore, prevention and early detection of osteoporosis should strive to substantially reduce this risk of fracture.

OBJECTIVE

The present observational, descriptive, cross-sectional study sought to assess the prevalence of risk factors for osteoporosis and fractures in a large sample of postmenopausal women aged 50 to 65 years attending Primary Care facilities in Spain.

METHODS

We recruited 4,960 women, at 96 Primary Care centers. Demographic and anthropometrical data, as well as information regarding risk factors for OP were collected using a questionnaire.

RESULTS

the prevalence rates for the major osteoporosis risk factors in our population were: low calcium intake, 43%; benzodiazepine use, 35.1%, and height loss, 30.1%. Other relatively prevalent factors include: having suffered at least one fall during the preceding year; positive family history of falls (particularly on the mother's side), smoking, kyphosis, presence of any disease affecting bone metabolism, personal history of falls, and inability to rise from a chair without using one's arms. The least frequent factors were weight loss of greater than 10% over the preceding 10 years and problems in sensory perception that affect patient's ability to walk.

CONCLUSIONS

The main risk factors for osteoporosis in women 50-65 years of age are low calcium intake, use of benzodiazepines, and observed loss of height. Our results may help physicians to identify groups at risk for OP and fractures at early stages and consequently, optimize prevention and early diagnosis of osteoporosis in postmenopausal women.

[Predictive value of ultra-sound densitometry as a method of selective screening for osteoporosis in primary care]

OBJECTIVE

To determine the cut-off point of calcaneous quantitative ultrasound densitometry (QUS) as a selection method in primary care for referral of postmenopausal women for dual energy x-ray absorptiometry (DXA).

DESIGN

Diagnostic techniques trial.

SETTING

Four general practices in the Basque Country Autonomous Region, Spain.

PARTICIPANTS

Randomly selected Caucasian women older than 45, chosen at random. A sample size of 146 women was used.

INTERVENTIONS

Calcaneous ultrasound bone mineral density (BMD) measurement, using Achilles Express(R) and DXA.

PRINCIPAL MEASUREMENTS

T-score BMD measurement on both devices. The sensitivity, specificity and positive predictive values of QUS and finally the ideal cut-off value were calculated.

RESULTS

The mean age of the sample was 58.2 (17.7) (range, 48-83 years old). The prevalence of women with osteoporosis, osteopaenia and normal DXA was 14.1%, 50.4% and 35.5%, respectively. The estimated sensitivity of QUS was 78.9% (56.7-91.5) and the specificity was 64.7% (55.6-72.8). The negative predictive value (NPV) was 94.9% (87.7-98.0) and the positive predictive value (PPV) was 26.8% (17.0-39.6). After the COR curve analysis, the ideal cut-off for QUS was determined as a T-score </= -2.0.

CONCLUSIONS

Given its high NPV, QUS can be considered a useful device for screening before DXA. Its low PPV means it has to be combined with other complementary or substitutive selective screening methods, such as predictive rules, which should be evaluated in each specific use.

Prevention of osteoporosis: four-year follow-up of a cohort of postmenopausal women treated with an ossein-hydroxyapatite compound

BACKGROUND

The long-term effects of ossein-hydroxyapatite compound (OHC), a drug used for osteoporosis prevention, have not been previously reported. The aim of this study was to assess the long-term efficacy of OHC in postmenopausal women with bone mineral density (BMD) in the osteopenia range.

METHODS

We performed a retrospective 4-year follow-up study in a primary-care setting to assess changes in BMD in a cohort of 112 postmenopausal women included in an osteoporosis programme that included health and dietary advice and who were treated with OHC 1660mg every 12 hours. BMD was measured annually in the distal part of the forearm, with T- and Z-score values being calculated for trabecular and total bone.

RESULTS

A progressive and statistically significant increase in BMD was observed in trabecular and total T- and Z-score mean values. At baseline, mean +/- SD trabecular T- and Z-scores were -1.27 +/- 0.7 and -1.03 +/- 0.7, respectively, and -0.86 +/- 0.7 and -0.62 +/- 0.7, respectively, at the end of the 4-year follow-up period (both p < 0.0001). Mild constipation was observed in 3.2% of patients during the follow-up period.

CONCLUSION

Ossein-hydroxyapatite compound could be an effective and safe agent for the prevention of bone loss in postmenopausal osteopenic women, with significant increases in BMD being observed in this group of patients.

Pharmacological treatment of osteoporosis for people over 70

Osteoporosis has been defined as "a systemic disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with consequent increase in bone fragility and susceptibility to fracture". The impact of osteoporosis is most pronounced in elderly populations who run the greatest risk of fractures. The probability of developing mainly hip, vertebral and other non-vertebral fractures (for example, a Colles fracture) not only depends on bone mineral density (BMD) but also on age. Older patients are more susceptible to fracture than younger patients with the same BMD T-score. As the older population increases, the incidence of osteoporotic fractures is expected to rise dramatically over the next few decades. Although hip fractures are considered to be the most severe and economically important osteoporotic fracture, vertebral fractures also lead to adverse health outcomes, including back pain, height loss and kyphosis. These changes may result in significant declines in physical performance, function and, ultimately, loss of independence. The challenge for physicians is to prevent bone loss, to diagnose and treat osteoporosis before fractures occur, and to treat patients who have already experienced a fracture to prevent recurrent fractures. The objective of this review is to analyze the capacity to reduce fractures as the key element to evaluate the effectiveness of available medications: calcium and Vitamin D, bone formation drugs, antiresortive drugs, and dual-effect drugs. In view of the paucity of information about treatment of osteoporosis in the elderly population, available studies were not designed with this objective, so that this article reviews data mostly deriving from post-hoc analysis or sub-analysis of the main phase III clinical trials of each of the tested medications.

[Proportion of individuals with indication criteria for bone densitometry and frequency of factors of risk of low osseous mass in primary care consultations]

OBJECTIVE

To find the number of individuals with indication for Bone Densitometry in Primary Care, according to the criteria of the WHO, the Agency for Evaluating Medical Technology of Catalonia (AETM) and the International Committee on Clinical Guides to Osteoporosis (CIGCO), and the frequency of factors of risk of low osseous mass.

DESIGN

Multi-centre, prospective, transversal study.

SETTING

Primary care consultations.

PARTICIPANTS

Patients over 18 (307 women and 139 men) with mean age of 54.3+/-16.8, who attended for consultation with an appointment.

MAIN MEASUREMENTS

Presence or absence of factors relating to each of the indication criteria for bone densitometry.

RESULTS

A 36.3% of individuals had indication of densitometry under the AETM criteria, 76.7% with the WHO criteria, and 50.5% with the CIGCO criteria (applicable only to women). Percentages increased with age and were higher for women. Concordance between the various criteria was under 37%.

CONCLUSIONS

The percentage of individuals with indication for bone densitometry was highly variable under different criteria. It was greater in women and increased with age. Concordance between different criteria was low.

Bone mineral density evolution in young premenopausal women with idiopathic osteoporosis

Idiopathic osteoporosis is a frequent cause of osteoporosis in young premenopausal women. However, there are no data about the treatment of these patients. The aim of this study was to analyse the evolution of bone mineral density (BMD) in premenopausal women with idiopathic osteoporosis treated with a conservative approach. Retrospective study of 16 premenopausal women with idiopathic osteoporosis (aged 35.7+/-7 years) with a mean follow-up period of 3 years (1-6 years). BMD measurements at the lumbar spine and femoral neck were obtained in all patients at baseline and yearly (patients had one or more fragility fractures and/or a Z score < -2 in the lumbar spine or femur). Secondary causes of osteoporosis were excluded in all patients. Patients were treated with calcium and vitamin D to achieve a calcium intake of up to 1,500 mg/day and were advised to increase physical activity. A significant increase in lumbar and femoral BMD was observed after 2 and 3 years of follow-up, respectively (1.9+/-1.9% mean increase in lumbar spine, p= 0.021, at 2 years) (5.6+/-4.5% mean increase in femur, p=0.04, at 3 years). The serum total alkaline phosphatase (TAP) values increased at 2 years (122+/-46 vs 140+/-36 U/l, p=0.054). In addition, a negative correlation between baseline TAP serum values and lumbar BMD evolution at 2 years was observed (r=-0.748, p=0.013). No patient developed new skeletal fractures during the follow-up period. In young premenopausal women with idiopathic osteoporosis the conservative treatment with supplements of calcium and vitamin D associated with an increase of physical activity is associated with an increase in BMD without evidence of further skeletal fractures after more than 3 years of follow-up.

Calcium-sensing receptor gene A986S polymorphism and bone mass in hypertensive women

BACKGROUND

The function of the calcium-sensing receptor (CaSR) is to maintain serum calcium concentration within a narrow physiological range. Two types of mutations have been described: activating that causes hypocalcemia and inactivating, which leads to hypercalcemia. The objective was to assess the effect of CaSR gene A986S polymorphism on the lumbar spine bone mass, calcium metabolism parameters and markers of bone remodeling in hypertensive women.

METHODS

The study included 48 patients (mean age 59 +/- 10 years) with mild-to-moderate hypertension, according to JNC VI and who did not present any associated diseases. We determined the following in all patients: Ca, P, Mg, PTHi, 25-vitamin D, 1,25-vitamin D, osteocalcin, deoxypyridinoline in urine, 24-h urine calcium. A bone densitometry of the lumbar spine was also performed. CaSR gene A986S polymorphism was also studied in all patients by PCR.

RESULTS

Genotype frequency was 69% for AA, 27% for AS and 4% for SS, with a prevalence of 82% for allele A and 18% for allele S. Patients with a lack of allele S had lower levels of p (3.5 +/- 0.5 vs. 4 +/- 0.4, p = .034). No differences in calcium plasma levels, urinary calcium excretion and bone mass were observed.

CONCLUSIONS

We found no clinical significance in the parameters studied of the CaSR gene A986S polymorphism in hypertensive women.

Prevalência de osteoporose: uma revisão crítica

A queda da mortalidade, seguida da redução da fecundidade e aumento da expectativa de vida, resulta no envelhecimento da população e no aumento das taxas de doenças crônico-degenerativas, entre as quais a osteoporose. Pesquisas epidemiológicas vêm sendo desenvolvidas com a finalidade de estimar sua prevalência na população empregando diferentes técnicas. O propósito dessa investigação foi revisar os estudos de prevalência de osteoporose e discutir suas implicações do ponto de vista da Saúde Coletiva. Foi realizada revisão da literatura mediante a qual foram incluídas publicações contendo estimativas de prevalência da osteoporose calculadas a partir da densidade mineral óssea aferida pela absorção de raios X de dupla energia. Os dados foram classificados segundo o ano, a região ou o país, autor, características da população investigada, e sítio esquelético. Os resultados mostraram ampla dispersão entre as taxas, com os valores variando entre 0,4% e 40,0% de acordo com o sítio pesquisado, o grupo etário, o sexo e o tipo de estudo. Nos estudos de base populacional, os valores das estimativas por ponto variaram de 7,9% a 16,0% considerando DMO no sítio femoral de mulheres com 50 e mais anos de idade. Nas áreas brasileiras mais desenvolvidas é necessário implementar projetos para conhecer sua prevalência incluindo-a na agenda dos formuladores de políticas públicas.

[Health-related quality of life in Spanish women with osteoporosis]

OBJECTIVE

To analyze the health-related quality of life in patients with osteoporosis and to compare it with the overall population.

METHODS

A cross-sectional descriptive study was carried out with 60 female patients of the rheumatology service at a university hospital, in Spain, from April to October 2003. The Short Form-36 (SF-36) questionnaire was applied in order to obtain demographic data, clinical characteristics and data about lifestyles related to health. Patients were classified in age groups. The statistics tests performed were Chi-square, general linear model, Student's t-test.

RESULTS

The interviewees' average age was 65.57 years old (SD: +/- 9.7 years), and average time interval for diagnosis was 3.4 +/- 2.84 years. The best scores were in social functioning (89), emotional aspects (72.2), mental health (63), and vitality (53.7). The lowest scores were in general health (45.1), physical capacity (47.7), pain (52.3) and physical aspects (59.9). The patients' average scores were lower than the general Spanish population's scores in the following dimensions: functional capacity, physical aspects, pain and overall health status. The greatest differences between the average SF-36 scores for patients and for the overall Spanish population were in the age group ranging from 55 to 64 years old. Scores were lower or similar to the general Spanish population in all other dimensions of the questionnaire. No significant associations were found between the dimensions of the SF-36 contemplated in this study and the clinical, demographic and lifestyle data.

CONCLUSIONS

The patients presented bad quality of life, particularly with respect to those dimensions that are most relevant with respect to osteoporosis, when compared with the overall Spanish population. The physical dimensions were the ones most affected.

[Prevalence of osteopenia and osteoporosis in postmenopausal women]

OBJECTIVE

To know the osteoponia and osteoporosis prevalence in postmenopausal women determined with broadband ultrasonic attenuation (BUA).

DESIGN

Descriptives cross-sectional study of prevalence.

SETTING

Salvador Allende Health Center. Valencia, Spain.

PARTICIPANTS

A total of 115 postmenopausal women aged 49 at 85 years old was studied, initiated in September to December 2003. Iatrogenic menopause or women with calcium, vitamin D, estrogen replacement therapy, estrogen receptor modulators, and biphosphonates therapy were considered criteria for exclusion. We measured bone mineral density with BUA at right calcaneus.

MAIN MEASUREMENTS

We analyzed the age, height, and weight, the result of BUA, tobacco and diuretics consumption and years of amenorrhea.

RESULTS

. The prevalence of osteoporosis was 50.4%. Other 29.6% had osteopenia. Of the postmenopausal women with osteoporosis, 27.6% were 70 to 75 years old. The 82.8% of postmenopausal women with osteoporosis were younger than 75 years old. The 66.7% postmenopausal women with body mass index lesser than 25 had osteoporosis.

CONCLUSIONS

The osteoporosis prevalence in our patients was greater than other studies (30%). Emphasis may be placed on screening osteoporosis with BUA in primary health care. We suggested that educational community programs should start at an earlier age to identify factors that contribute to maintaining bone mineral density among postmenopausal women.

Severity of cholestasis and advanced histological stage but not menopausal status are the major risk factors for osteoporosis in primary biliary cirrhosis

BACKGROUND

Since primary biliary cirrhosis (PBC) is usually diagnosed in postmenopausal women with minor cholestasis, it has been questioned whether PBC itself represents a further risk for osteoporosis.

AIM

To assess the prevalence and risk factors for osteoporosis in an unselected series of women with PBC.

PATIENTS AND METHODS

142 women with PBC (age: 54.3+/-0.8 years) and an age-matched control group. Osteoporosis was established by densitometry (bone mineral density below -2.5 T-score). Age, duration and severity of PBC, body mass index, menopausal status, histological stage and markers of bone turnover were assessed.

RESULTS

Prevalence of osteoporosis was higher in PBC (32.4%) than in normal women (11. 1%) (RR: 3.83, 95%CI: 2.59-5.67, P<0.001). Osteoporosis was associated with older age, menopausal status, body mass index, longer PBC duration, advanced histological stage, high bilirubin and alkaline phosphatase, and low albumin and prothrombin index. Regression analysis identified older age, higher Mayo risk score, lower body mass index and advanced histological stage but not menopause as the independent risk factors for osteoporosis.

CONCLUSIONS

Osteoporosis is more prevalent in women with PBC than in the general population. Age and severity of the disease, but not menopausal status, are the main risk factors for osteoporosis in this liver disease.

[Indication of bone densitometry in women over 40 years of age]

OBJECTIVE

To evaluate the indication of bone densitometry (BD) and to know the prevalence of risk factors (FR) for osteoporotic fracture in primary care.

DESIGN

Cross-sectional, descriptive study.

SETTING

Urban centre of health of Terrassa, Barcelona (52.000 h).

PARTICIPANTS

Women over 40 years old than went to urgencies of the centre selected by consecutive sampling stratified by age (n=416).

MAIN MEASUREMENTS

Registry of FR for osteoporotic fracture according to the criteria of the Agència d'Avaluació de Tecnologies Mèdiques (AATM), hygienic-dietetic recommendations received and made BDs.

RESULTS

The average age was of 60+/-13 years. The FR for osteoporotic fracture more prevalence were: low calcium intake (32.1%), increased age (27.5%), no lactation (24.9%), and precocious menopause (16.4%). They had received dietetic recommendations 35.7%, of exercise 65.5% and solar exhibition 18.1%. Of the 177 (42.7%) cases in that the BD was indicated only it made in 45 (25.4%) and of 237 (57.3%) without indication of BD they were made 41 (17.2%). To have made BD is related of statistically significant way to antecedent of osteoporotic fracture (P<.001) and to iatrogenic menopause (P<.001). The 41.2% of the BDs were asked for by the primary care physician, the 34.1% by the rheumatologist and the 16.5% by the gynaecologist. The indication of BD varies between the different scientific societies: AATM 42.7%, semFYC 45.7%, FORE 49.8%, SER 61.1%, and NOF 64.3%.

CONCLUSIONS

Although FR of prevalence osteoporosis are most modifiable from primary care, a low degree of advice exists on healthful habits of life. A low accomplishment of BDs is detected and half is not adapted its indications according to the criteria of the AATM. There is great variability in the indication of BD between the different scientific societies.

Prevalence of osteoporosis using DXA bone mineral density measurements at the calcaneus: cut-off points of diagnosis and exclusion of osteoporosis

The objective of this article is to evaluate different T-score cut-off points in the calcaneus in order to establish the prevalence of osteoporosis in the general population and to evaluate the clinical value of bone mineral density at the calcaneus as a tool to identify patients with spine or hip osteoporosis. A total of 1455 people (727 women and 728 men) from the Hortega cohort were studied. The densitometric studies were carried out in the calcaneal region using a Peripheral Instantaneous X-ray Imaging (PIXI) Lunar bone densitometer. We established three cut-off points (-1.6, -2.0, -2.5). One-hundred twenty-five patients (67 men with a mean age of 47 +/- 13 yr and 58 women with a mean age of 66 +/- 8 yr) from internal medicine outpatient clinics who were undergoing densitometry of the calcaneus, spine, and hip were subsequently studied. The prevalence of osteoporosis in women with a calcaneus T-score -1.6 was 12.4%, which is comparable to the 12.7% obtained with an axial densitometer in a Spanish population. The prevalence in men was 7.8%, with a calcaneus T-score of <-2.0. In women, the highest sensitivity (85%) was obtained with a calcaneus T-score of <-1.0 and the highest specificity with a calcaneus T-score of <-2.5. In men, the best sensitivity (61%) was obtained with a calcaneus T-score of <-1.0 and the best specificity (98%) with a calcaneus T-score of <-2.5. A calcaneus T-score <-1.6 is an adequate cut-off to establish the prevalence of osteoporosis in population studies. In women, a calcaneus T-score of >-1.0 enables the diagnosis of the disease to be excluded, whereas a calcaneus T-score of <-2.5 enables the diagnosis to be confirmed and treatment to be initiated in both men and women.

Bone Mineral Density in Menopausal Women with Primary Hyperparathyroidism before and after Parathyroidectomy

The relationship between osteoporosis and primary hyperparathyroidism (pHPT) has not been definitely established because both diseases occur predominantly in postmenopausal women, and because PTH has a paradoxical effect on bone. We have investigated the prevalence of reduced bone mineral density (BMD) in women with pHPT, its relationship with metabolic parameters, and its course after parathyroidectomy. A prospective observational study was carried out on perimenopausal and postmenopausal women consecutively diagnosed and operated on for pHPT. Demographic data were recorded, as well as, PTH, Ca, calciuria/24h, P, vitamin D, adenoma weight. The BMD was measured at three sites: femoral neck (FN), proximal femur (PF), and lumbar spine (LS). Fifty-two patients were included with a mean age of 61+/-12 years. The prevalence of reduced BMD (< or = 1SD, T-score) was 80%-100% depending on site. Parathyroid hormone was higher in patients with osteoporosis (319+/-181 pg/ml) than in those with osteopenia (230+/-83 pg/ml) or normal BMD (148+/-81 pg/ml;p < 0,04). Twenty-eight patients were investigated 1 year after parathyroidectomy. The BMD improved significantly at all sites, particularly in patients with osteoporosis. Age correlated inversely with BMD increases at the femoral sites (r= -0,47;p = 0,02) but not at the LS. 25-OHD3 plasma levels correlated inversely with BMD increases at PF (r= -0,76; p < 0,0001). In pHPT, there is a high prevalence of BMD abnormalities. No metabolic variables had a definite influence on BMD values but a tendency was observed for lower BMD in severe pHPT. One year after parathyroidectomy, there were significant BMD increases that were more marked at femoral sites, in younger patients, in patients with preoperative osteoporosis, and in those with lower plasma levels of 25-OHD3.

The ECOS-16 questionnaire for the evaluation of health related quality of life in post-menopausal women with osteoporosis

BACKGROUND

The aim of this study is to validate the questionnaire ECOS-16 (Assessment of health related quality of life in osteoporosis) for the evaluation of health related quality of life (HRQoL) in post-menopausal women with osteoporosis.

METHODS

An observational, prospective and multi-centre study was carried out among post-menopausal women with osteoporosis in primary care centres and hospital outpatient clinics. All patients attended 2 visits: at baseline and at 6 months. In addition, the subgroup of outpatients attended another visit a month after the baseline to assess the test-retest reliability. The psychometric properties of the questionnaire were evaluated in terms of feasibility, validity (content validity and construct validity) and internal consistency in baseline, and in terms of test-retest reliability and responsiveness to change in visit at month and visit at 6 months, respectively. In all visits, ECOS-16, EUROQoL-5D (EQ-5D) and four 7-point items about health status (general health status, back pain, limitation in daily activities and emotional status) were administered, whereas only outpatients were given MINI-OQLQ (Mini Osteoporosis Quality of Life Questionnaire), besides all clinical variables; and sociodemographic variables at baseline.

RESULTS

316 women were consecutively included, 212 from primary care centres and 104 from hospital outpatient clinics. Feasibility: 94.3% of patients answered all items of the questionnaire. The mean administration time was 12.3 minutes.

VALIDITY

factor analysis suggested that the questionnaire was unidimensional. In the multivariate analysis, patients with vertebral fractures, co-morbidity and a lower education level showed to have worse HRQoL. Moderate to high correlations were found between the ECOS-16 score and the other health status questionnaires (0.47-0.82). Reliability: internal consistency (Cronbach's alpha) was 0.92 and test-retest reliability (ICC) was 0.80. Responsiveness to change: ECOS-16 scores increased according to change perceived by the patient, as well as the effect size (ranges between 1.35 to 0.43), the greater the perception of change in patients' general health status, the greater the changes in patients' scores. The Minimal Clinically Important Difference (MCID) suggested a change of 0.5 points in the ECOS-16 score, representing the least improvement in general health status due to their osteoporosis: "slightly better".

CONCLUSION

ECOS-16 has been proven preliminarily to have good psychometric properties, so that it can be potentially a useful tool to evaluate HRQoL of post-menopausal women with osteoporosis in research and routine clinical practice.

Prevalencia de factores de riesgo de osteoporosis y fracturas osteoporóticas en una serie de 5.195 mujeres mayores de 65 años

BACKGROUND AND OBJECTIVE

Although the risk factors of osteoporosis are well known, their prevalence in the general population has not been clearly analyzed. The aim of the present study was to determine the prevalence of several risk factors for osteoporosis and fragility fractures in a population of women from Spain.

PATIENTS AND METHOD

We recruited 5,195 women aged 65 year or older, attended in 58 primary care centers. Recruitment was done through a non-probabilistic sampling of consecutive cases. Demographic, anthropometric, and clinical variables were collected, and subjects were administered a questionnaire of risk factors for osteoporosis and fragility fractures.

RESULTS

The prevalence of main osteoporosis risk factors was: early menopause (< 45 years): 25.4%; history of fragility fractures: 20.1%; familial history of fragility fractures: 16.7%; low weight (< 57 kg): 14.6%. Any of these four factors was present in 56.3% of women. 26.2% of women were treated with benzodiazepines, and 26.7% reported at least one fall during the previous year. We noticed a low prevalence of several risk factors that are commonly reported in Anglo-Saxon series including tobacco and alcohol consumption, low calcium intake and thyroid hormone treatment.

CONCLUSIONS

Besides age, the main risk factors of osteoporosis and fragility fractures in our series were a history of fragility fractures, early menopause, benzodiazepine use and previous falls. The evaluation of these risk factors may be an useful tool to identify women at high risk for osteoporosis and to implement appropriate clinical strategies.

[Quantitative bone ultrasound: impact of the application of two different reference databases to a population of 5.195 postmenopausal women]

BACKGROUND AND OBJECTIVE

The application of different reference databases to calculate the T-score values of the bone mineral density (BMD) using dual-energy X-ray absorptiometry techniques may result in variations in the number of subjects diagnosed with osteoporosis. There are no similar dataregarding quantitative bone ultrasound. To compare the results of the application of two different reference databases: the manufacturer's normal range and the Spanish normative data.

PATIENTS AND METHOD

Evaluation of the heel ultrasound with a Sahara sonometer in 5,195 women >= 65 year-old who were attended for any reason in primary care centers.

RESULTS

Bone ultrasound estimated BMD T-score mean values were 1.27 and 1.29 when applying the manufacturer's normal range and the Spanish normative data, respectively (p = 0.001). Percentages of women with a T-score below 2.50 standard deviations were 12.7% and 12.8% respectively.

CONCLUSIONS

The application of these two reference databases shows very similar results which, although statistically different, are clinically irrelevant.

Bone mass and bone modelling markers in hypertensive postmenopausal women

Numerous phosphocalcium alterations associated with bone mineral density in hypertension have been described, but very few studies assess them. This study assesses bone mass in hypertensive postmenopausal women and the hypertension influence determining both calcium homeostasis and bone turnover markers. Blood and urine samples were analysed for calcium metabolism-related parameters. Densitometry studies were conducted in the lumbar spine (L2-L4). Hypertensive osteoporotic women--selected from 82 women, with 22% osteoporosis prevalence, similar to the rate for the same age in the Spanish population--had significantly higher levels of body mass index (29+/-4 vs 26+/-4, P=0.019), calciuria (293+/-146 vs 210+/-116 mg/24 h, P=0.023) and calcium/creatinine ratio (0.33+/-0.2 vs 0.22+/-0.1 P=0.003) vs hypertensive nonosteoporotic women. No relation was found between systolic and diastolic blood pressure with bone mass. However, there was a negative osteocalcin correlation (r=-0.386, P=0.0001, and r=-0.242, P=0.033). Calciuria is associated with bone mass decrease in hypertensive women, and there is no relation between bone mass and blood pressure.

[Diagnosing osteoporosis in primary care in Spain (ABOPAP 2000 study)]

OBJECTIVE

To discover how osteoporosis is tackled in Spanish primary care before the publication of the semFYC osteoporosis guide.

DESIGN

Self-filled questionnaire for primary care doctors sent out by commercial mail (in blocks per province).

SETTING

Five thousand family medicine clinics in Spain.Participants. Doctors working in primary care.Measurements. Level of activity relating to osteoporosis in daily consultations (identification of risk factors, screening, who conducts diagnosis and follow-up, level of access to densitometry and specialist) and identification data (province, type of work centre and number of consultations per day).

MAIN RESULTS

414 replies embracing reformed and non-reformed centres from the entire country, with different case overloads. 32.3% stated that osteoporosis treatment was viewed as a preventive activity in their centre and only 35.5% systematically asked for family history of osteoporosis. Osteoporosis screening was high in determined situations (82.9% in vertebral compression, 78.3% in hip fracture) and deficient in others (59.6% in glucocorticoid treatment, 46.6% in colles fractures, 36% in chronic nephropathy, 29.2% in thinness, 17.1% in chronic hepatopathy and 11.8% in treatment for epilepsy or with lithium). 73.9% could not request bone densitometry and 64.3% thought that access to other care levels was complicated. 51.9% said they continued to monitor osteoporosis. The impossibility of requesting densitometry or difficult access conditioned the screening level. There were differences in access according to autonomous communities, with Catalonia having best access to Densitometry (75%), followed by the communities of Madrid, Valencia and Euskadi (30%).

CONCLUSIONS

Diagnosis of osteoporosis in primary care is deficient and is partly conditioned by difficulty in access to diagnostic tests and the lack of systematic screening.