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Clinical Trial
. 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

Susan L Greenspan  1 , Subashan Perera, David Nace, Kimberly S Zukowski, Mary A Ferchak, Carroll J Lee, Smita Nayak, Neil M Resnick
Affiliations
Clinical Trial

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

Susan L Greenspan et al. J Am Geriatr Soc. 2012 Apr.

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.

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Conflict of interest statement

Conflict of Interest: The editor inchief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper.

Figures

Figure 1
Figure 1
The percent of residents eligible for treatment based on clinical fractures (Clinical Fx); Clinical fractures or bone mineral density osteoporosis classification: (Clinical Fx or BMD); Clinical fractures, BMD or vertebral fractures (Clinical Fx, BMD or VF); FRAX algorithm using femoral neck BMD (FRAX-FN); FRAX using body mass index (FRAX-BMI); or clinical fractures or heel ultrasound osteoporosis classification (Clinical Fx or Heel US).
Figure 2
Figure 2
A.) Venn diagram illustrating number of patients eligible for treatment based on criteria for bone mineral density (BMD), vertebral fractures (VF) or clinical fractures (Clinical Fx) and overlap of the 3 criteria. Fifty-four patients were not eligible for treatment. B.) Venn diagram illustrating number of patients eligible for treatment based on criteria for bone mineral density (BMD), clinical fractures (Clinical Fx) or fracture risk algorithm (FRAX-FN, using femoral neck BMD) and overlap of the 3 criteria. Thirty-seven patients were not eligible for treatment.
Figure 3
Figure 3
A.) Venn diagram illustrating number of patients eligible for treatment based on criteria for bone mineral density (BMD), vertebral fractures (VF) or fracture risk algorithm (FRAX-FN, using femoral neck BMD) and overlap of the 3 criteria. Nineteen patients were not eligible for treatment. B.) Venn diagram illustrating number of patients eligible for treatment based on criteria for clinical fractures (Clinical Fx); vertebral fractures (VF) or heel ultrasound (Heel US) and overlap of the 3 criteria. Sixty patients were not eligible for treatment.
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References

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