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J Am Geriatr Soc. 2012 Apr;60(4):684-90. doi: 10.1111/j.1532-5415.2011.03884.x. Epub 2012 Feb 8.

FRAX or fiction: determining optimal screening strategies for treatment of osteoporosis in residents in long-term care facilities.

Author information

1
Medicine, Division of Endocrinology, University of Pittsburgh, Pittsburgh, PA 15213, USA. greenspn@pitt.edu

Abstract

OBJECTIVES:

To examine screening strategies for osteoporosis and fractures for treatment of long-term care residents.

DESIGN:

Cross-sectional analysis to examine screening strategies for treatment.

SETTING:

Assisted living and skilled care facilities.

PARTICIPANTS:

Two hundred two frail women aged 65 and older (mean 85), excluding those receiving bisphosphonates.

MEASUREMENTS:

Clinical fractures of the hip or spine (Clin Fx); Clin Fx or bone mineral density (BMD); Clin Fx, BMD, or vertebral fractures (VF) assessed according to dual-energy X-ray absorptiometry-based vertebral fracture assessments; fracture risk algorithm using femoral neck BMD (FRAX-FN); fracture risk algorithm using body mass index (FRAX-BMI); or Clin Fx or heel ultrasound (heel US).

RESULTS:

Treatment eligibility ranged from 17% (Clin Fx) to 98% (FRAX-BMI). VFs were found in 47%, 74% of which were silent. Criteria with Clin Fx, BMD, or VF identified 73% of study participants for treatment. FRAX-FN suggested treatment in 81% but would have missed approximately 10% of individuals with silent VFs. Clin Fx or heel US suggested that 39% of participants were eligible for treatment.

CONCLUSION:

Long-term care residents eligible for osteoporosis treatment ranged from fewer than 20% to roughly all residents depending on screening criteria. VFs are common and identify a subset of residents missed by conventional BMD scans or FRAX-FN. A reasonable clinical approach could consider treatment for those with Clin Fx of the hip or spine, radiological evidence of a VF, or osteoporosis according to BMD classification. Prospective studies are needed to determine optimal screening strategies for treatment in this cohort.

PMID:
22316237
PMCID:
PMC3477847
DOI:
10.1111/j.1532-5415.2011.03884.x
[Indexed for MEDLINE]
Free PMC Article

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