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South Med J. 2012 Jan;105(1):11-7. doi: 10.1097/SMJ.0b013e3182e1b57.

An approach to identify rural women aged 60 to 64 for osteoporosis treatment.

Author information

  • 1Department of Medicine, West Virginia University School of Medicine, Charleston, WV, USA. apfister@hsc.wvu.edu

Abstract

OBJECTIVES:

The US Preventive Services Task Force recently recommended that women younger than 65 years undergo a bone mineral density screening if clinical risk factors (CRFs) of a major osteoporotic fracture are ≥9.3% for a period of 10 years. We sought the most cost-effective approach to identify older, rural women who are eligible for osteoporosis treatment.

METHODS:

We evaluated CRFs and peripheral forearm densitometry (pDXA) in 277 rural women aged 60 to 64 years for treatment eligibility. We compared three strategies of universal screening-pDXA, CRFs, and exclusion of pDXA in specific situations (prior fracture and CRFs ≥20%)-followed by CRF evaluation with pDXA confirmation in the residual population.

RESULTS:

Our sample showed that 37.5% of women had CRFs at a ≥9.3% cutoff threshold. Only osteoporotic pDXA values were significantly higher at this threshold. Current estrogen use was significantly associated with diminished treatment eligibility (P = 0.001). Body mass index correlated poorly with pDXA values (r = 0.12) and CRFs (r = 0.21). Although a cost-savings strategy nonsignificantly identified more women who were eligible for treatment using the three strategies (P = 0.25), significantly fewer pDXA examinations were required (P < 0.001).

CONCLUSIONS:

Initiating treatment in rural women aged 60 to 64 years who had a prior fracture or CRFs ≥20% without pDXA confirmation, followed by pDXA evaluations in the residual population with CRFs between ≥9.3% and 20%, significantly reduced the number of pDXA examinations and the cost of screening.

PMID:
22189661
[PubMed - indexed for MEDLINE]
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