期刊
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
卷 60, 期 4, 页码 684-690出版社
WILEY
DOI: 10.1111/j.1532-5415.2011.03884.x
关键词
osteoporosis; long-term care; FRAX
资金
- Holleran family and National Institutes of Health (NIH) [R01 AG028068]
- University of Pittsburgh [RFA-RM-06-002]
- Clinical Translational Science Institute [Ul1 RR024153 NIH/NCRR]
- Pittsburgh Older American's Independence Center [P30 AG024827, 2K24DK062895]
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. J Am Geriatr Soc 60:684-690, 2012.
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