Prevalence and predictors of osteoporosis risk in orthopaedic patients.
BACKGROUND
Current physician practices are not effective in adequately evaluating and treating patients for osteoporosis. While dual-energy xray absorptiometry is the gold standard in evaluating bone mineral density, calcaneal quantitative ultrasound has emerged as a low-risk and low-cost alternative.


OBJECTIVE
We estimated the prevalence of abnormal bone mineral density with calcaneal quantitative ultrasound and developed criteria for risk stratification in female and male orthopaedic patients.


METHODS
We enrolled 500 patients (331 women, 169 men) with a mean age of 67 years (range, 55-94 years) and screened them for osteoporosis with calcaneal quantitative ultrasound. Multivariate logistic regression was used to identify predictors of low bone mineral density and a risk model was developed.


RESULTS
Quantitative ultrasound identified 154 patients with low bone mineral density at the time of enrollment. The prevalence of abnormal bone mineral density was 31% (women: 38%, men: 17%). Multivariate analysis demonstrated age, female gender, smoking, wrist fracture, and spinal deformities independently predicted low bone mineral density. The probability of low bone mineral density among patients with more than one risk factor was greater than 50% among women and greater than 30% among men.


CONCLUSIONS
Low bone mineral density is common among orthopaedic outpatients. Age, female gender, smoking, wrist fractures, and spinal deformities are independent risk factors for osteoporosis. We present a probability model designed to assist orthopaedic surgeons in identifying high-risk patients and initiating adequate preventative measures.


METHODS
Level I, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
Rozental
Tamara D
TD
Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA, 02215, USA. trozenta@bidmc.harvard.edu
Shah
Jalaal
J
Chacko
Aron T
AT
Zurakowski
David
D
D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D002111:Calcaneus / Q000000981:diagnostic imaging / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis* / Q000453:epidemiology / Q000378:metabolism*; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism; D011237:Predictive Value of Tests; D015995:Prevalence; D011364:Professional Practice; D012307:Risk Factors; D012737:Sex Factors; D014463:Ultrasonography