A clinical decision rule to enhance targeted bone mineral density testing in healthy mid-life women

Hawker, Gillian; Mendel, Arielle; Lam, Melody; Akhavan, Pooneh; Cancino-Romero, J.; Waugh, Esther J.; Jamal, Sophie A.; Mian, Samra; Jaglal, Susan

doi:10.1007/s00198-011-1862-0

Cited by 20 publications

(9 citation statements)

References 27 publications

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“…Most of the osteoporosis screening algorithms available currently include "years since menopause" as one of the variables, which measures the duration of estrogen deprivation in women. For instance, a screening algorithm developed by Hawker et al (2012) to identify Canadian women (age ≥40 years) with low bone mass includes "years since menopause" as a predictor [33]. "Years since menopause" was considered but it was not predictive of bone health status among women in this study.…”

Section: Discussionmentioning

confidence: 98%

Development of Osteoporosis Screening Algorithm for Population Aged 50 Years and above in Klang Valley, Malaysia

Subramaniam

Chan

Soelaiman

et al. 2020

IJERPH

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Background: The current osteoporosis screening instruments are not optimized to be used among the Malaysian population. This study aimed to develop an osteoporosis screening algorithm based on risk factors for Malaysians. Methods: Malaysians aged ≥50 years (n = 607) from Klang Valley, Malaysia were interviewed and their bone health status was assessed using a dual-energy X-ray absorptiometry device. The algorithm was constructed based on osteoporosis risk factors using multivariate logistic regression and its performance was assessed using receiver operating characteristics analysis. Results: Increased age, reduced body weight and being less physically active significantly predicted osteoporosis in men, while in women, increased age, lower body weight and low-income status significantly predicted osteoporosis. These factors were included in the final algorithm and the optimal cut-offs to identify subjects with osteoporosis was 0.00120 for men [sensitivity 73.3% (95% confidence interval (CI) = 54.1%–87.7%), specificity 67.8% (95% CI = 62.7%–85.5%), area under curve (AUC) 0.705 (95% CI = 0.608–0.803), p < 0.001] and 0.161 for women [sensitivity 75.4% (95% CI = 61.9%–73.3%), specificity 74.5% (95% CI = 68.5%–79.8%), AUC 0.749 (95% CI = 0.679–0.820), p < 0.001]. Conclusion: The new algorithm performed satisfactorily in identifying the risk of osteoporosis among the Malaysian population ≥50 years. Further validation studies are required before applying this algorithm for screening of osteoporosis in public.

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Section: Discussionmentioning

confidence: 98%

Development of Osteoporosis Screening Algorithm for Population Aged 50 Years and above in Klang Valley, Malaysia

Subramaniam

Chan

Soelaiman

et al. 2020

IJERPH

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“…Prior research has shown that, among 944 healthy women in Ontario referred for a baseline DXA test at midlife, more than 90% had normal bone density. 12 Similarly, in a US cohort of 615 women aged 49 years or more who received a baseline DXA test, Schnatz and colleagues 13 found that 40% did not meet the North American Menopause Society criteria for testing. 2 In a recent study involving 4957 women aged 67 years or more with normal bone mineral density or osteopenia, osteoporosis was detected in less than 10% during rescreening intervals of about 15 years.…”

Section: Discussionmentioning

confidence: 99%

Impact of a change in physician reimbursement on bone mineral density testing in Ontario, Canada: a population-based study

et al. 2014

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CMAJ OPEN, 2(2) E45 Research CMAJ OPENA bone mineral density test using dual-energy x-ray absorptiometry (DXA) evaluates the quantity of bone mineral and is used to make a diagnosis of reduced bone mass or osteoporosis and to provide information that contributes to an assessment of fracture risk. Together with other risk factors for fracture, information gained from a bone mineral density test can guide clinicians and patients in understanding the risk of an osteoporosis-related fracture; it can also inform decisions aimed at mitigating these risks (e.g., initiation of bisphosphonates treatment). 1,2Clinical practice guidelines in Canada currently recommend bone mineral density testing in at-risk populations, namely all men and women aged 65 years or more and those who have had a fragility fracture after age 40 years.2,3 The recommended management model is based on assessment of fracture risk, which is derived in part from measured bone mineral density and appears on bone mineral density reports for most patients over age 50. For patients assessed as high risk, guidelines indicate that there is good evidence to support pharmacotherapy; for those assessed as low risk, guidelines state that patients are unlikely to benefit from pharmacotherapy and should be reassessed in 5 years.3 Thus, bone mineral density testing, as well as knowledge of clinical risk factors that can modify the assessment of fracture risk, are important components of prevention efforts to reduce (secondary) fracture risk. 1,3 In the province of Ontario, Canada, a sharp increase in the rate of bone mineral density testing among women aged 40-44 years, for whom fracture risk is typically low, was observed Background: On Apr. 1, 2008, a revision was made to the fee schedule for bone mineral density testing with dual-energy x-ray absorptiometry (DXA) in the province of Ontario, Canada, reducing the frequency of repeat screening in individuals at low risk of osteoporosis. We evaluated whether the change in physician reimbursement successfully promoted appropriate bone mineral density testing, with reduced use among women at low risk and increased use among women and men at higher risk of osteoporosis-related fracture.

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“…Our data support this with the majority of normal BMD cases (78.4 %) occurring in those 50-64 years of age, and the majority of osteoporosis diagnoses (84.8 %) occurring in patients 65 years of age and older. In a study of 944 middle-aged women in Ontario, Canada referred for baseline DXA testing, inappropriate DXA referral was evident as more than 90 % had normal BMD [19]. Similarly, in a US cohort of 615 women 49 years of age and older who underwent baseline DXA, 40 % did not meet North American Menopause Society guidelines for screening [20].…”

Section: Discussionmentioning

confidence: 99%

Bone mineral density screening and its accordance with Canadian clinical practice guidelines from 2000–2013: an unchanging landscape in Saskatchewan, Canada

et al. 2015

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A clinical decision rule to enhance targeted bone mineral density testing in healthy mid-life women

Abstract: Among healthy mid-life women receiving a baseline BMD test, few had low bone mass, supporting the need for guidance about testing. A prediction rule with four risk factors had improved sensitivity over the OST. Further validation is warranted.

Cited by 20 publications

References 27 publications

Development of Osteoporosis Screening Algorithm for Population Aged 50 Years and above in Klang Valley, Malaysia

Development of Osteoporosis Screening Algorithm for Population Aged 50 Years and above in Klang Valley, Malaysia

Impact of a change in physician reimbursement on bone mineral density testing in Ontario, Canada: a population-based study

Bone mineral density screening and its accordance with Canadian clinical practice guidelines from 2000–2013: an unchanging landscape in Saskatchewan, Canada

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