Neck of femur fracture screening
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]
Overview
The risk of neck of femur fracture due to osteoporosis is threatening, affecting one out of two postmenopausal women and one out of five men older than 50 years. The 10-year risk for an osteoporosis-related neck of femur fracture in a 65-year-old white woman with no other risk factor is 9.3%. According to the guidelines of USPSTF, all women ≥ 65 years old along with women < 65 years old with a high risk of fracture are the target of screening for osteoporosis, but there is not any recommendation to screen men for the disease. Dual energy x-ray absorptiometry (DEXA) of both hip and lumbar spine bones and quantitative ultrasonography of the calcaneus are two major methods suggested for screening osteoporosis.
Screening
Risk assessment
The risk of neck of femur fracture due to osteoporosis is threatening, affecting one out of two postmenopausal women and one out of five men older than 50 years. Osteoporosis usually affects the Caucasian population. The rate of osteoporosis is higher in the elderly. The 10-year risk for osteoporosis-related distal radius fracture in a 65-year-old white woman with no other risk factor is 9.3%. .
Screening criteria
The US Preventive Services Task Force (USPSTF) divides the population into three groups, categorizing them on the basis of their need to be screened for osteoporosis. They include:
- Women of age ≥ 65 year, without any fracture history or pathological reason for osteoporosis
- Women of age <65 years, with 10-year fracture risk of not less than a 65-year-old white woman (who has not any other risk factor)
- Men with no history of osteoporosis
According to the guidelines of USPSTF, the first two groups (women) are the target of screening for osteoporosis. There is no recommendation to screen the third group (men) for the disease.[1]
The USPSTF recommendations from 2002 included:
- All women of 65 and older should be screened by bone marrow densitometry.[2]
- Women aged 60-64 years old, who are at increased risk of fracture. The most significant risk factor for indicating an increased probability of having osteoporosis is low body weight (< 70 kg).
- Clinical prediction rules are available to guide the selection of women for screening.
- The Osteoporosis Risk Assessment Instrument (ORAI) is the most sensitive strategy.[3]
- Regarding the screening process for men, a cost-analysis study suggests that screening may be "cost-effective for men with a self-reported prior fracture beginning at age 65 years, and for men 80 years and older with no prior fracture".[4]
Screening tool
There are two major methods, that are suggested to be used for screening for osteoporosis:
- Dual energy x-ray absorptiometry (DEXA) of both hip and lumbar spine bones
- Quantitative ultrasonography of the calcaneus
Advantages of ultrasonography over DXA scan:
Although quantitative ultrasonography has numerous advantages when compared to DXA but still current diagnostic and treatment criteria rely on DXA of the hip and lumbar spine. The advantages include:
- Lower cost
- More portable
- Lower ionizing radiation exposure
Screening protocol
After an initial screening is done for bone mineral density (BMD), optimal intervals to repeat the tests include:[5]
- 15 years for women with normal bone density or mild osteopenia: T-score of greater than −1.50
- 5 years for women with moderate osteopenia: T-score of −1.50 to −1.99
- 1 year for women with advanced osteopenia: T-score of −2.00 to −2.49
References
- ↑ U.S. Preventive Services Task Force (2011). "Screening for osteoporosis: U.S. preventive services task force recommendation statement". Ann Intern Med. 154 (5): 356–64. doi:10.7326/0003-4819-154-5-201103010-00307. PMID 21242341.
- ↑ U.S. Preventive Services Task Force (2002). "Screening for osteoporosis in postmenopausal women: recommendations and rationale". Ann. Intern. Med. 137 (6): 526–8. PMID 12230355.
- ↑ Martínez-Aguilà D, Gómez-Vaquero C, Rozadilla A, Romera M, Narváez J, Nolla JM (2007). "Decision rules for selecting women for bone mineral density testing: application in postmenopausal women referred to a bone densitometry unit". J. Rheumatol. 34 (6): 1307–12. PMID 17552058.
- ↑ Schousboe JT, Taylor BC, Fink HA; et al. (2007). "Cost-effectiveness of bone densitometry followed by treatment of osteoporosis in older men". JAMA. 298 (6): 629–37. doi:10.1001/jama.298.6.629. PMID 17684185.
- ↑ Gourlay ML, Fine JP, Preisser JS, May RC, Li C, Lui LY, Ransohoff DF, Cauley JA, Ensrud KE (2012). "Bone-density testing interval and transition to osteoporosis in older women". N. Engl. J. Med. 366 (3): 225–33. doi:10.1056/NEJMoa1107142. PMC 3285114. PMID 22256806.