FRAX or fiction: determining optimal screening strategies for treatment of osteoporosis in residents in long-term care facilities.
OBJECTIVE
To examine screening strategies for osteoporosis and fractures for treatment of long-term care residents.


METHODS
Cross-sectional analysis to examine screening strategies for treatment.


METHODS
Assisted living and skilled care facilities.


METHODS
Two hundred two frail women aged 65 and older (mean 85), excluding those receiving bisphosphonates.


METHODS
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.


CONCLUSIONS
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.
Medicine, Division of Endocrinology, University of Pittsburgh, Pittsburgh, PA 15213, USA. greenspn@pitt.edu
Susan L
SL
Greenspan
Subashan
S
Perera
David
D
Nace
Kimberly S
KS
Zukowski
Mary A
MA
Ferchak
Carroll J
CJ
Lee
Smita
S
Nayak
Neil M
NM
Resnick
D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015994:Incidence; D008134:Long-Term Care; D008403:Mass Screening / Q000379:methods*; D010024:Osteoporosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D058866:Osteoporotic Fractures / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
D050071:Bone Density Conservation Agents; D004164:Diphosphonates