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Clinical risk factors as predictors of postmenopausal osteoporosis in general practice.
Br J Gen Pract. 2001 Oct; 51(471):806-10.BJ

Abstract

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.

Authors+Show Affiliations

Department of General Practice, Leiden University Medical Centre, PO Box 2088, 2301 CB Leiden, The Netherlands. R.G.J.A.Versluis@lumc.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11677703

Citation

Versluis, R G., et al. "Clinical Risk Factors as Predictors of Postmenopausal Osteoporosis in General Practice." The British Journal of General Practice : the Journal of the Royal College of General Practitioners, vol. 51, no. 471, 2001, pp. 806-10.
Versluis RG, Papapoulos SE, de Bock GH, et al. Clinical risk factors as predictors of postmenopausal osteoporosis in general practice. Br J Gen Pract. 2001;51(471):806-10.
Versluis, R. G., Papapoulos, S. E., de Bock, G. H., Zwinderman, A. H., Petri, H., van de Ven, C. M., & Springer, M. P. (2001). Clinical risk factors as predictors of postmenopausal osteoporosis in general practice. The British Journal of General Practice : the Journal of the Royal College of General Practitioners, 51(471), 806-10.
Versluis RG, et al. Clinical Risk Factors as Predictors of Postmenopausal Osteoporosis in General Practice. Br J Gen Pract. 2001;51(471):806-10. PubMed PMID: 11677703.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical risk factors as predictors of postmenopausal osteoporosis in general practice. AU - Versluis,R G, AU - Papapoulos,S E, AU - de Bock,G H, AU - Zwinderman,A H, AU - Petri,H, AU - van de Ven,C M, AU - Springer,M P, PY - 2001/10/27/pubmed PY - 2002/1/5/medline PY - 2001/10/27/entrez SP - 806 EP - 10 JF - The British journal of general practice : the journal of the Royal College of General Practitioners JO - Br J Gen Pract VL - 51 IS - 471 N2 - 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. SN - 0960-1643 UR - https://www.unboundmedicine.com/medline/citation/11677703/Clinical_risk_factors_as_predictors_of_postmenopausal_osteoporosis_in_general_practice_ L2 - https://bjgp.org/cgi/pmidlookup?view=long&pmid=11677703 DB - PRIME DP - Unbound Medicine ER -