Does this woman have osteoporosis?
BACKGROUND
Although recent US Preventive Services Task Force guidelines recommend bone densitometry for all women older than 65 years, identifying younger women at increased risk for osteoporosis and women with occult vertebral fractures remains a clinical challenge. We investigated whether physical signs are useful as a screening tool either for early referral to bone densitometry or for occult spinal fractures.


OBJECTIVE
To review the accuracy and precision of physical examination findings for the diagnosis of osteopenia, osteoporosis, or spinal fracture.


METHODS
We conducted a MEDLINE search for articles published from 1966 through August 2004, manually reviewed bibliographies, consulted 4 clinical skills textbooks, and contacted experts in the field.


METHODS
Studies were included if they contained adequate original data on the accuracy or precision of physical examination for diagnosing osteopenia, osteoporosis, or spinal fracture. Two authors screened abstracts found by the search. Fourteen of 191 full articles reviewed met inclusion criteria.


METHODS
Two authors independently abstracted data from the included studies. Disagreements were resolved by discussion.


RESULTS
No single maneuver is sufficient to rule in or rule out osteoporosis or spinal fracture without further testing. The following yielded the greatest positive likelihood ratios (LR+): weight less than 51 kg, LR+, 7.3 (95% confidence interval [CI], 5.0-10.8); tooth count less than 20, LR+, 3.4 (95% CI, 1.4-8.0); rib-pelvis distance less than 2 finger breadths, LR+, 3.8 (95% CI, 2.9-5.1); wall-occiput distance greater than 0 cm, LR+, 4.6 (95% CI, 2.9-7.3), and self-reported humped back, LR+, 3.0 (95% CI, 2.2-4.1).


CONCLUSIONS
In patients who do not meet current bone mineral density screening recommendations, several convenient examination maneuvers, especially low weight, can significantly change the pretest probability of osteoporosis and suggest the need for earlier screening. Wall-occiput distance greater than 0 cm and rib-pelvis distance less than 2 fingerbreadths suggest the presence of occult spinal fracture.
Green
Amanda D
AD
Ambulatory Care Service, Durham Veterans Affairs Medical Center, Durham, NC, USA.
Colón-Emeric
Cathleen S
CS
Bastian
Lori
L
Drake
Matthew T
MT
Lyles
Kenneth W
KW
D015502:Absorptiometry, Photon; D000368:Aged; D001851:Bone Diseases, Metabolic / Q000175:diagnosis; D005260:Female; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis* / Q000503:physiopathology; D010808:Physical Examination; D018570:Risk Assessment; D016103:Spinal Fractures / Q000175:diagnosis