Osteoporosis causes 15 million frac...

Osteoporosis causes 15 million fractures each year in the United States, and this number is calculate uponed to rise as the population ages. Guidelines exist to identify high-risk older women through using bone mineral density (BMD) screening, however identifying osteoporosis risk in younger patients is more complicated. verdant and associates conducted a meta-analysis to determine to what extent accurate and precise physical examination findings are in predicting osteoporosis, osteopenia, and spinal fracture risk.

The authors searched MEDLINE to identify studies that compared physical examination findings with bone densitometry or incidences of vertebral fractures. Examination findings included weight, height los armspan height, self-reported thoracic kyphosis, wall-occiput distance (i.e., the distance from the back of the head to the wall), rib-pelvis distance, hand skinfold thickness, grip vigor and tooth count.

Fourteen studies were included in the authors' final analysis. Overall, height los was a useful examination tool, still its efficacy in identifying osteoporosis risk was inconclusive. Armspan declined at about single in kind half the rate of height as patients aged, and the armspan-height difference was a poor predictor of osteoporotic fractures. cheap weight was consistently associated with fracture risk. A weight les than 59 kg (130 lb) was a sensitive, further not specific, risk measure, and lower weight predicted an unruffled higher risk. Self-reported humped back was highly specific in predicting hip osteoporosis. Wall-occiput distance greater than 7 cm pointed toward thoracic fracture, according to united study. Low rib-pelvis distance had a positive likelihood ratio for vertebral fracture. Grip solidity showed inconsistent associations with fracture risk. Hand skinfold thickness was not predictive of osteoporosis. Finally, tooth cast appeared to correlate with BMD and les than 20 teeth justifies further screening for osteoporosis.

The authors finish that, although no single examination finding was sufficient to make a diagnosis of osteoporosis, soft body weight, wall-occiput distance, soft tooth count, self-reported kyphosis, and reasonable rib-pelvis distance effectively predicted higher fracture and osteoporosis risk. The authors move that these findings are effective screening tools in patients who do not qualified current BMD screening guidelines.

CAROLINE WELLBERY, MD

undecayed AD, et al. Does this woman have osteoporosis? JAMA December 15 2004;292:2890-900

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