Comparison of the Achilles Express ultrasonometer with central dual-energy X-ray absorptiometry

Prevalence of osteoporosis in the Italian population and main risk factors: results of BoneTour Campaign

BACKGROUND

BoneTour is a campaign conducted throughout the Italian territory for the assessment of Italian people bone status and for the prevention of osteoporosis.

METHODS

A total of 7305 sequential subjects of both sexes were screened, collecting clinical data through the FRAX™ questionnaire, and measuring heel bone stiffness by Quantitative Ultrasonography (QUS). The 10-year risk for hip and major osteoporotic fractures was calculated taking into account personal or family history of fragility fracture, smoking, alcohol abuse, rheumatoid arthritis, prolonged steroids assumption. Additional risk factors were evaluated, including early menopause, poor sunlight exposure, low dietary calcium intake, physical inactivity, number of pregnancies, months of lactation, tobacco cigarettes smoked per year, specific causes of secondary osteoporosis. Through a correlation study, the influence of each factor on the development of osteoporosis was analyzed.

RESULTS

As many as 18 % of women suffer from osteoporosis, as defined by QUS T-score. The calculation of FRAX™ confirmed the weight of the already known risk factors. The correlation study revealed the significance of some additional factors, such as hyperthyroidism, nephrolithiasis, Crohn disease, ulcerative colitis, celiac disease, poor sun exposure, and oophorectomy before age 50.

CONCLUSIONS

The high prevalence of secondary osteoporosis in the Italian population clearly indicates the importance of additional risk factors not yet included in the FRAX™ algorithm, for which preventive measures should be considered. Screening campaigns may allow both early diagnosis and access to treatment.

Prevalence and predictors of osteoporosis risk in orthopaedic patients

BACKGROUND

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.

QUESTIONS/PURPOSES

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Bone health screening, education, and referral project in northwest Iowa: creating a model for community pharmacies

OBJECTIVE

To identify women 60 years of age or older at risk for osteoporosis, provide education, and refer at-risk women to physicians through a community pharmacy screening program and to develop a model in community pharmacies for this service.

DESIGN

Cross-sectional study.

SETTING

Northwest Iowa between August 2005 and October 2005.

PARTICIPANTS

159 women 60 years of age or older screened at five pharmacies.

INTERVENTIONS

Five pharmacies completed education on osteoporosis, received training on use of the Achilles InSight by GE Lunar, and screened women 60 years of age or older for osteoporosis. Patients received education on osteoporosis and risk factors during the screening and were stratified as low, moderate, or high risk based on a T-score. Patients at risk were referred to their physician for further evaluation. Pharmacists telephoned patients at 3 and 6 months after screening to determine self-initiated or provider-initiated changes in their treatment plan.

MAIN OUTCOME MEASURES

Descriptive population characteristics, proportion of participants with medical risk factors for osteoporosis, proportion of patients screened at risk, and proportion of physician or patient self-initiated changes instituted as a result of the screening.

RESULTS

Of the 159 women screened, 53% were rated as moderate or severe risk and referred to their physicians. Three- and 6-month follow-up results revealed a high proportion of self-initiated lifestyle or medication changes and a small proportion of physician-initiated changes.

CONCLUSION

The majority of women 60 years of age or older who attended a community pharmacy osteoporosis screening were at moderate or high risk for osteoporosis. A fee-for-service model was created for community pharmacists to improve recognition and treatment of patients at risk. A toolkit will be created for pharmacists to promote their role in improving the bone health of older patients.