FRAX or Fiction:: Determining Optimal Screening Strategies for Treatment of Osteoporosis in Residents in Long-Term Care Facilities

• Autores: Susan L. Greenspan, Subashan Perera, David A. Nace, Kimberly S. Zukowski, Mary A. Ferchak, Carroll J. Lee, Smita Nayak, Neil M. Resnick
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 60, Nº. 4, 2012, págs. 684-690
• Idioma: inglés
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• Resumen

  • 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.