Clinical risk factors as predictors of postmenopausal osteoporosis in general practice.

Autor: Versluis RG; Department of General Practice, Leiden University Medical Centre, PO Box 2088, 2301 CB Leiden, The Netherlands. R.G.J.A.Versluis@lumc.nl, Papapoulos SE, de Bock GH, Zwinderman AH, Petri H, van de Ven CM, Springer MP
Jazyk: angličtina
Zdroj: The British journal of general practice : the journal of the Royal College of General Practitioners [Br J Gen Pract] 2001 Oct; Vol. 51 (471), pp. 806-10.
Abstrakt: Background: Case-finding strategies to identify women with high risk for osteoporotic fractures have recently been proposed, but little information about such an approach in general practice is known.
Aim: To study the validity of the proposed case-finding strategy for osteoporosis.
Design of Study: Survey using case-finding strategy.
Setting: Seven hundred and twelve women aged between 55 and 84 years, randomly selected from a general practice in The Netherlands.
Method: Of the 712 randomly selected women, 449 women participated. Information was obtained from a questionnaire, direct questioning, and computerised patients files. Bone mineral density of the femoral neck was measured by dual energy X-ray absorptiometry and vertebral morphometry was performed on lateral X-rays of the spine. Osteoporosis was defined by a bone mineral density T-score of less than 2.5 and/or the presence of severe vertebral deformities. Sensitivity, specificity, and predictive values were calculated for the whole set of risk factors; those significantly associated with osteoporosis and in logistic models.
Results: Clinical risk factors were present in 55% of the women and identified 68% of the women with osteoporosis. Three risk factors--a low body mass index, fragility fractures, and severe kyphosis and/or loss of height--were associated significantly with osteoporosis; they were present in 33% of the women and identified 60% of those with osteoporosis. A logistic model based on age and fragility fractures selected 32% of the women and identified 76%.
Conclusion: No single risk factor could assist in identifying women with osteoporosis. A simplified case-finding strategy using only three risk factors, that is suitable for primary care, reduces the number of women to be evaluated by two-thirds; however, this is at the cost of missing the diagnosis in 40% of the women with osteoporosis. Addition of spine radiographs to the case-finding approach helped to obtain a better risk profile of the women and had also practical consequences for the management of some. We propose that radiographs should be included in any case-finding strategy.
Databáze: MEDLINE