title: Osteoporosis is underdiagnosed in skilled nursing facilities: a large-scale heel BMD screening study.
abstract: OBJECTIVE
  To investigate the common assertion that osteoporosis is underdiagnosed in the skilled nursing facility setting.
  
  
  METHODS
  Skilled nursing facilities participated in a nationwide heel-screening study conducted by their local consultant pharmacists. The nursing facility residents were categorized into 4 age groups: 59 years and younger; 60 to 69 years; 70 to 79 years; and 80 years and older. Residents were screened on a voluntary basis. Heel scanning was performed using a peripheral dual-energy x-ray absorptiometry (pDXA) machine, and the data were collected by an independent contractor (On-Site Wellness). Residents were grouped by low, moderate, or high risk for osteoporosis based on their bone mineral density (BMD) T-scores. Bedridden patients, patients with a short life expectancy, and those currently receiving osteoporosis therapy were excluded from the study.
  
  
  RESULTS
  A total of 34,486 residents of skilled nursing facilities in 26 states were screened, 7728 (22.4%) of whom were grouped as low risk, 12,095 (35.1%) as moderate risk, and 14,663 (42.5%) as high risk for osteoporosis and related fracture. Findings by state were comparable to those for the total study population.
  
  
  CONCLUSIONS
  This large-scale heel-screening study suggests a considerable prevalence of undiagnosed osteoporosis (as measured by peripheral DXA scans) in skilled nursing facilities, underscoring the need for more vigilant awareness of fracture risk in these patients.
authors.affiliation: Johns Hopkins University School of Medicine, University of Maryland School of Medicine, Victory Springs Senior Health Associates, Reisterstown, MD, USA.
authors.forename: F Michael
authors.initials: FM
authors.lastname: Gloth
authors.forename: William
authors.initials: W
authors.lastname: Simonson
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis* / Q000453:epidemiology*; D012866:Skilled Nursing Facilities; D014481:United States / Q000453:epidemiology