title: Assessment of osteoporosis in family medicine obtained by ultrasound densitometry.
abstract: BACKGROUND
  Osteoporosis is a disease characterized by a decrease in bone mineral density, making bones become less rigid, and therefore susceptible to fractures, either spontaneously or with force, which is lower than otherwise needed for healthy bones fractured. Nearly 10% of the world population and 30% of women after menopause, suffer from osteoporosis. Clinical assessment of osteoporosis in family medicine is key to prevention, early detection and treatment of osteoporosis.
  
  
  OBJECTIVE
  To investigate the possibility of early detection and diagnosis of osteoporosis by analyzing the risk factors for osteoporosis and to compare the results with the parameters obtained by ultrasound densitometry of calcaneus, and determine the relationship of calcaneus densitometry with DXA findings, as the gold standard for the diagnosis of osteoporosis.
  
  
  METHODS
  The study included all patients of Family Medicine Kalesija Team 1, aged 50 years and over, a total of 711 patients, of whom 425 were women and 286 men. In all patients we assessed the existence of the following risk factors for osteoporosis: Constitutional: gender, age, weight, constitution, menarche and menopause, loss of height and stooped posture; Living habits: smoking, alcohol consumption, coffee, physical activity, and medications: long-term use corticosteroids, anticonvulsants, antacids, thyroid hormones. Comorbidity: history of fractures, hyperthyroidism, COPD, Chussing's disease, diabetes. In the group of high-risk patients determined by the clinical assessment, quantitative ultrasound densitometry screening was carried out. Monitoring parameters derived with densitometry: the value of T-score, BUA (Broadband Ultrasound Attenuation), SOS (Speed of Sound), QUI (Quantitative Ultrasound Index). To confirm the diagnosis of osteoporosis, in all patients with positive findings using ultrasound densitometry (T score lower than 2.5), another densitometry was performed by standard DXA method.
  
  
  RESULTS
  The incidence of osteoporosis was 96% in women and 4% in men. Differences in prevalence between men and women are statistically significant. People with and without osteoporosis significantly differ in gender, age, weight, constitution (BMI-Body Mass Index). The parameters that distinguish those with and without osteoporosis: age, weight, height, BMI, gender. Out of the total of 711 patients, in 11% of patients the clinical evaluation showed the existence of high risk of osteoporosis. In 9.8% patients, the values were determined by ultrasound densitometry, where T score was lower than 2.5 what induces a high risk of fractures, and for 8.8% patients the DXA confirmed the diagnosis of osteoporosis.
  
  
  CONCLUSIONS
  Clinical assessment of osteoporosis in the family medicine clinic performed in timely and focused history of risk factors for osteoporosis, with additional findings from quantitative densitometry of calcaneus, was sufficient for the early detection and screening of patients with high risk for osteoporosis. With good clinical assessment of osteoporosis it will be necessary to send all patients who enter the high-risk group to undergo ultrasound densitometry of calcaneus, to make it possible to determine the risk of bone fractures and osteoporosis in time, and then refer patients for further processing and DXA measurements according to the guidelines by the WHO.
authors.affiliation: Primary Health Care Center Kalesija, Kalesija, Bosnia and Herzegovina.
authors.forename: Esad
authors.initials: E
authors.lastname: Alibasic
authors.affiliation: Primary Health Care Center and Polyclinics Dr Mustafa Sehovic, Tuzla, Bosnia and Herzegovina.
authors.forename: Enisa
authors.initials: E
authors.lastname: Ramic
authors.affiliation: Primary Health Care Center and Polyclinics Dr Mustafa Sehovic, Tuzla, Bosnia and Herzegovina.
authors.forename: Olivera
authors.initials: O
authors.lastname: Batic Mujanovic
authors.affiliation: Primary Health Care Center Kalesija, Kalesija, Bosnia and Herzegovina.
authors.forename: Enes
authors.initials: E
authors.lastname: Avdibasic
authors.affiliation: Primary Health Care Center Kalesija, Kalesija, Bosnia and Herzegovina.
authors.forename: Damir
authors.initials: D
authors.lastname: Husic
authors.affiliation: Primary Health Care Center Zenica, Zenica, Bosnia and Herzegovina.
authors.forename: Alma
authors.initials: A
authors.lastname: Alic
keywords: bone density; early detection; osteoporosis.; quantitative ultrasound densitometry; risk factors