High detection rate of osteoporosis with screening of a general hospitalized population: a 6-year study in 6406 patients in a university hospital setting

Abstract

Background: Osteoporosis is a highly prevalent disease identified by Dual Energy X-ray Absorptiometry (DEXA) that can be performed in an ambulatory (out-patient) or hospitalized population. We evaluated the use of baseline in-hospital DEXA screening to identify osteoporosis in ambulatory care and hospitalized patients; we also assessed specific risk factors for osteoporosis among these populations.

Methods: We included a baseline initial DEXA from 6406 consecutive patients at our tertiary referral University Hospital.

Results: Osteoporosis was diagnosed in 22.3% of the study population. In univariate analysis, osteoporosis risk factors were age, fracture history and low BMI (for all 3 sites), but also corticotherapy (lumbar spine and femoral neck) and male (lumbar spine). In multivariate analysis, age, fracture history, low BMI, and male increased osteoporosis risk. In-hospital screening yielded a higher percentage of osteoporosis positive scans than ambulatory care screening (31.8% vs 18.5%, p < 0.001). In-hospital screening targeted an older and more predominantly male population with a higher fracture history. Z-scores revealed that this difference was not only due to an older age of the population and mainly concerned cortical bone.

Conclusions: In-hospital osteoporosis screening revealed more osteoporosis than screening in ambulatory practice and could be an additional tool to improve the identification and management of osteoporosis. In addition to typical risk factors, we identified male gender as associated with osteoporosis detection in our cohort.

Keywords: Dual energy X-ray absorptiometry; Hospitalization; Male; Osteoporosis.

Fig. 1

Percentage of normal, osteopenic and osteoporotic patients according to the year of DEXA examination for the whole population

Fig. 2

Comparison between the percentage of osteoporotic patients by year in ambulatory and hospitalized patients. The grey horizontal line represented the 2007–2012 mean percentage in the hospitalized sub-population. The black horizontal line represented the percentage in the ambulatory sub-population