Osteoporosis by forearm bone densitometry in postmenopausal women in West Virginia

Forearm bone densitometry examination predicts the relative risk of osteoporotic fracture, but not as reliably as central densitometry of the hip and spine. The ease of performance, inexpensiveness, and mobility of this technique makes it especially appealing in rural states like West Virginia. After evaluating 1,321 Caucasian women in West Virginia by peripheral bone densitometry at the proximal 1/3 radius region, we found a 26.6% prevalence of osteoporosis. This is higher when compared to estimates using central densitometry and could potentially lead to overprescribing of expensive medications. Although central densitometry is the preferred method for the diagnosis of osteoporosis, women ages 65 or older with osteoporosis identified by peripheral densitometry should likewise be treated. Clinical risk factors should be present before initiating treatment in younger postmenopausal women ages 50-64. In those women without risk factors, confirmation by central densitometry should be performed if possible.     

Tooth loss and bone mineral density among women: a cross-sectional survey

OBJECTIVE: We examined the association between total tooth loss and bone mineral density to determine whether the former can be used as a surrogate marker of the latter. DESIGN: A community based cross-sectional survey. SETTING: The community-study area of the Faculty of Medicine, Galle. PARTICIPANTS: A group of randomly selected 327 women volunteers aged 32 to 97 years. MEASUREMENTS: Anthropometry, total number of teeth lost and bone mineral density (BMD) of the lumbar spine and proximal femur. RESULTS: In categorical analysis, after adjusting for possible confounding factors, mean BMDs of the spine and proximal femur showed no significant differences in the thirds of the total tooth loss. In regression analysis, a loss of one tooth was negatively associated with spine BMD of premenopausal women by 0.003 g/cm2 and the trochanteric BMD of postmenopausal and all women by 0.001 g/cm2. These associations, however, were not seen in other skeletal sites. CONCLUSIONS: Total tooth loss did not show a uniform and significant association with bone mineral density, measured at relevant skeletal sites. Total tooth loss as a surrogate marker of low bone density cannot be justified in this population of women.     

Experiences of occupational violence in Australian urban general practice: a cross-sectional study of GPs

OBJECTIVE: To establish the prevalence and characteristics of occupational violence in Australian urban general practice, and examine practitioner correlates of violence. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional questionnaire survey mailed to all members (n = 1085) of three urban divisions of general practice in New South Wales in August and September 2004. The three divisions were chosen to provide a range of socioeconomic status (SES) demographics. MAIN OUTCOME MEASURES: Occupational violence towards general practitioners during the previous 12 months. RESULTS: 528 GPs returned questionnaires (49% response rate). Of these, 63.7% had experienced violence in the previous year. The most common forms of violence were "low level" violence - verbal abuse (42.1%), property damage/theft (28.6%) and threats (23.1%). A smaller proportion of GPs had experienced "high level" violence, such as sexual harassment (9.3%) and physical abuse (2.7%). On univariate analysis, violence was significantly more likely towards female GPs (P < 0.001), less experienced GPs (P = 0.003) and GPs working in a lower SES status area (P < 0.001), and among practice populations encompassing greater social disadvantage (P = 0.006), mental health problems (P < 0.001), and drug- and alcohol-related problems (P < 0.001). Experience of violence was greater for younger GPs (P = 0.005) and those providing after-hours care (P = 0.033 for after-hours home visits). On multivariate analysis, a significant association persisted between high level violence and lower SES area (odds ratio [OR], 2.86), being female (OR, 5.87), having practice populations with more drug-related problems (OR, 5.77), and providing home visits during business hours (OR, 4.76). More experienced GPs encountered less violence (OR, 0.77) for every additional 5 years of practice. CONCLUSION: Occupational violence is a considerable problem in Australian urban general practice. Formal education programs in preventing and managing violence would be appropriate for GPs and doctors-in-training.     

The association between birthweight and current blood pressure: a cross-sectional study in an Australian Aboriginal community

OBJECTIVES: To study the relationship of blood pressure to birthweight and current body mass index in a population with high rates of low birthweight (< 2.5 kg). DESIGN: A cross-sectional population screening program conducted between 1992 and 1998, with retrospective retrieval of birthweights. SETTING: A remote coastal Australian Aboriginal community with a high prevalence of diabetes, cardiovascular and renal disease. PARTICIPANTS: Eighty-two per cent of the community members (1473/1805) were screened. Birthweights were available for 767 (71%) of the screened participants aged 7-43 years. MAIN OUTCOME MEASURES: The association between birthweight and current blood pressure, accounting for current body mass index. RESULTS: Mean birthweights were low, and 18% of children and 35% of adults had been low-birthweight babies. In children (7-17 years), blood pressure was not correlated with birthweight, but in adults there was an inverse correlation - a 1 kg increase in birthweight was associated with a 2.9 mmHg (95% CI, 0.3-5.5 mmHg) decrease in systolic blood pressure, after adjusting for age, sex and current weight. Overweight adults with low birthweight had the highest blood pressures. CONCLUSIONS: Low birthweight is significantly associated with higher blood pressure in adult life, and the effect is amplified by higher current weight. Given the high rates of low birthweight in Aboriginal people in remote areas, and the detrimental effect of higher blood pressures on chronic diseases (currently present in epidemic proportions), interventions should focus on improving birthweights and on weight control in adolescents and adults. Special attention should be paid to children with low birthweight to avoid their becoming overweight in adult life.     

Clinical use of bone densitometry: clinical applications

Osteoporosis represents a difficult problem for physicians because, although many diagnostic tests are available, interpreting their results is not straightforward. As a result, many patients, even those with clear indications such as long-term steroid therapy or vertebral fractures on radiography, do not get screened or treated. Current evidence-based guidelines recommend screening for all white women older than 65 years and not already receiving an osteoporosis treatment and for many nonwhite women. For postmenopausal women who are younger than 65 years and have strong risk factors for osteoporosis, screening may also be beneficial. The optimal testing strategy depends on what is available locally. The best role for follow-up testing is still being defined, and interpretation of such testing is tricky. Reports of results can be hard to understand; a randomized controlled trial of clearer reports increased testing and decreased confusion about the meaning of test results. Densitometry might be more effectively used in practice if strategies such as having patients fill out a short questionnaire to assess for risk factors or creating a nurse-based system were used to identify patients. Clinicians need better approaches for identifying patients most likely to benefit from screening, systems that facilitate their application, and test results that are easy to interpret.      

Clinical use of bone densitometry: scientific review

Context  Osteoporosis causes substantial morbidity and costs $13.8 billion annually in the United States. Measurement of bone mass by densitometry is a primary part of diagnosing osteoporosis and deciding a preventive treatment course. Bone mineral densitometry has become more widely available and commonly used in practice. Objective  To review evidence about the value of various clinical applications of bone densitometry. Data Sources  A MEDLINE search was performed to update previous meta-analyses of the relationship between various measurements of bone density and risk of vertebral and hip fracture. We used data from the prospective Study of Osteoporotic Fractures to estimate risk of fracture from bone density and age in postmenopausal women. Study Selection and Data Extraction  When available, meta-analyses and systematic reviews are emphasized in the review. Data Synthesis  Bone mineral density (BMD) predicts fracture and can be used in combination with age to estimate absolute risk of fractures in postmenopausal white women. Hip BMD predicts hip fracture more strongly than other measurements of BMD. There are insufficient data to translate BMD results into risk of fracture for men and nonwhite women. The benefits of treatments to prevent fractures depend on BMD: women with osteoporosis have a greater risk of fractures and greater benefit from treatments than women without osteoporosis. Conclusions  Guidelines based on systematic reviews and a cost-effectiveness analysis have suggested that it is worthwhile to measure BMD in white women older than 65 years and perhaps to use risk factors to select younger postmenopausal women for densitometry. Other potential clinical applications of BMD that have not yet been adequately studied include screening men or nonwhite women, monitoring BMD in patients receiving treatment, and using BMD to identify patients who should be evaluated for secondary causes of osteoporosis.      

Evaluation of decision rules for referring women for bone densitometry by dual-energy x-ray absorptiometry.

CONTEXT: Identification of women with low bone mineral density (BMD) is an important strategy in reducing the incidence of osteoporotic fractures. However, screening all women is not recommended. OBJECTIVES: To assess the diagnostic properties of 4 decision rules--Simple Calculated Osteoporosis Risk Estimation (SCORE), Osteoporosis Risk Assessment Instrument (ORAI), Age, Body Size, No Estrogen (ABONE), and body weight less than 70 kg (weight criterion)--for selecting women for dual-energy x-ray absorptiometry (DXA) testing and to compare results with recommendations made in the National Osteoporosis Foundation (NOF) practice guidelines. DESIGN AND SETTING: Analysis of data from the Canadian Multicentre Osteoporosis Study, a population-based community sample, collected from 9 study centers across Canada between February 1996 and September 1997. PARTICIPANTS: Postmenopausal women aged 45 years or older (N = 2365) without bone disease who had DXA data for the femoral neck, data to apply selection criteria, and who were not currently taking estrogens or who had been taking hormone replacement therapy for 5 or more years. MAIN OUTCOME MEASURES: Sensitivity, specificity, and area under the receiver operating characteristic (AUROC) curve of each of the 4 decision rules and the NOF guidelines for identifying women with a BMD T score of less than -1.0 SD, less than -2.0 SD, and no more than -2.5 SD at the femoral neck, and percentages of women recommended for testing, stratified by BMD level and age. RESULTS: The percent of women with a BMD T score less than -1, less than -2, and no more than -2.5 were 68.3%, 25.4%, and 10.0%, respectively. The AUROC curves were greatest using SCORE and ORAI. The sensitivity for identifying women with a BMD T score of less than -2.0 was 93.7% (95% confidence interval [CI], 91.8%-95.6%) using the NOF guidelines and was 97.5% (95% CI, 96.3%-98.8%), 94.2% (95% CI, 92.3%-96.1%), 79.1% (95% CI, 75.9%-82.3%), and 79.6% (95% CI, 76.4%-82.8%), respectively, using the SCORE, ORAI, ABONE, and weight criterion. However, the NOF guidelines also resulted in 74.4% (95% CI, 71.3%-77.6%) of women with a normal BMD (T score of -1.0 or higher) being tested compared with 69.2% (95% CI, 65.9%-72.5%), 56.3% (95% CI, 52.7%-59.8%), 35.8% (95% CI, 32.4%-39.2%), and 38.1% (95% CI, 34.6%-41.6%), respectively, using the 4 decision rules. Assessments suggest that ABONE and weight criterion are not useful case-finding approaches. CONCLUSION: The SCORE and ORAI decision rules are better than the NOF guidelines at targeting BMD testing in high-risk patients. The acceptability of these rules in clinical practice merits further investigation given their potential effect on the use of densitometry services.     

Bone densitometry in assessment of bone mineral density

Osteoporosis is a serious disease characterized by low bone mineral density. Osteoporosis affects 24 million people annually and may be responsible for devastating hip, wrist and spinal fractures. Bone mineral density is considered the best predictor for osteoporotic fracture. Progress has been made toward noninvasive assessment of bone mineral density to provide early diagnosis of osteoporosis. A variety of methods are used to assess bone mineral density. These methods are presented and dual energy X-ray absorptiometry is discussed in detail.     

A study of bone densitometry in patients with complex regional pain syndrome after stroke

INTRODUCTION—This study was undertaken to evaluate the bone mineral density (BMD) in patients with complex regional pain syndrome type-I (CRPS-I) after stroke, and to correlate it with various clinical and neurophysiological parameters.
PATIENTS AND METHODS—Twenty patients with CRPS-I after stroke were included and a detailed neurological evaluation was carried out. The severity of CRPS-I was graded on the basis of shoulder hand syndrome score. All the patients underwent bone mineral densitometry of paralysed and non-paralysed forearm by dual energy x ray absorptiometry. The BMD of paralysed forearm was also compared with that of age matched healthy controls. Neurophysiological tests included sympathetic skin response in both upper and lower limbs and median somatosensory evoked potentials.
RESULTS—The mean age of patients was 57.2 (45-75) years and eight were females. Eight patients had severe weakness and 12 had moderate weakness of grade 2 on the hemiplegic side. There was significant reduction in BMD in the patients compared with controls (p<0.01). The bone density reduction correlated well with duration of illness (r = −0.673, p<0.01), shoulder hand syndrome score (r = −0.804, p<0.01), and Canadian neurological scale score (r = −0.738 p<0.01). Sympathetic skin response was not recordable bilaterally in all patients. Median somatosensory evoked potentials were not recordable in seven out of 20 patients who also had higher grade of CRPS-I.
CONCLUSION—Our results show significant reduction of BMD in patients with CRPS-I after stroke. The reduction in BMD correlates with the severity of shoulder hand syndrome score, degree of weakness, duration of hemiplegia, and the severity of stroke.


     

Development and validation of the Osteoporosis Risk Assessment Instrument to facilitate selection of women for bone densitometry

BACKGROUND: Although mass screening for osteoporosis is not recommended among postmenopausal women, there is no consensus on which women should undergo testing for low bone mineral density. The objective of this study was to develop and validate a clinical tool to help clinicians identify which women are at increased risk for osteoporosis and should therefore undergo further testing with bone densitometry. METHODS: Using Ontario baseline data from the Canadian Multicentre Osteoporosis Study, we identified all cognitively normal women aged 45 years or more who had undergone testing with dual-energy x-ray absorptiometry (DXA) at both the femoral neck and the lumbar spine (L1-L4). Participants who had a previous diagnosis of osteoporosis or were taking bone active medication other than ovarian hormones were excluded. The main outcome measure was low bone mineral density (T score of 2 or more standard deviations below the mean for young Canadian women) at either the femoral neck or the lumbar spine. Logistic regression analysis and receiver operating characteristic (ROC) analysis were used to identify the simplest algorithm that would identify women at increased risk for low bone mineral density. RESULTS: The study population comprised 1376 women, of whom 926 were allocated to the development of the tool and 450 to its validation. A simple algorithm based on age, weight and current estrogen use (yes or no) was developed. Validation of this 3-item Osteoporosis Risk Assessment Instrument (ORAI) showed that the tool had a sensitivity of 93.3% (95% confidence interval [CI] 86.3%-97.0%) and a specificity of 46.4% (95% CI 41.0%-51.8%) for selecting women with low bone mineral density. The sensitivity of the instrument for selecting women with osteoporosis was 94.4% (95% CI 83.7%-98.6%). Use of the ORAI represented a 38.7% reduction in DXA testing compared with screening all women in our study. INTERPRETATION: The ORAI accurately identifies the vast majority of women likely to have low bone mineral density and is effective in substantially decreasing the need for all women to undergo DXA testing.     

Comparison of bone mineral density and Fracture Risk Assessment Tool in Saudi women with and without type 2 diabetes mellitus: A cross-sectional study

Objectives:To compare the bone mineral density and the fracture risks in Saudi women with and without type 2 diabetes mellitus (T2DM).Methods:This cross-sectional study was carried out at Taibah Early Diagnostic Center, Al Madinah Al Munawarah, Saudi Arabia. A total of 465 women with and without T2DM aged ≥40 years who visited the center for a dual-energy X-ray absorptiometry scan between December 2020 and July 2021 were randomly selected. The 10-year probabilities of major osteoporotic fracture (MOF) and hip fracture (HF) were calculated using the Abu Dhabi Fracture Risk Assessment Tool (FRAX) with and without adjustment for T2DM. The adjustment was made by setting rheumatoid arthritis as the equivalent risk for T2DM in the FRAX. Bone mineral density values and the FRAX scores were compared between women with T2DM and non-diabetes.Results:Of 465 women, 214 had T2DM, and 251 were non-diabetics. The mean age of women was 59.42±7.9 years. There were no significant differences in mean age, menopausal status, height, weight, and body mass index between T2DM and non-diabetic women. Bone mineral density values and the unadjusted FRAX scores were comparable between the 2 groups. However, after adjusting FRAX for T2DM, the FRAX for MOF and HF became significantly higher in T2DM women (p=0.000 and p=0.004).Conclusion:In Saudi women with T2DM, unadjusted FRAX underestimated the risk of MOF and HF. Type 2 diabetes mellitus should be included as one of the clinical risk factors for fracture in future versions of the FRAX score.     

北京地区成年女性急迫性尿失禁现况调查

目的 调查北京地区成年妇女急迫性尿失禁（UUI）的患病率及影响因素。方法本研究通过分层多阶段系统抽样方法,在北京市6个区县48个村（居委会）对20岁以上成年女性进行入户问卷调查。问卷内容包括调查对象人口统计学信息、分娩情况、患病情况和UUI相关临床资料。应用SPSS16．0软件进行数据分析。结果3058名成年女性完成本项调查,UUI患病率为1．7％（52／3058）。单因素分析,UUI和非UUI女性在年龄、文化程度、家庭收入、妊娠次数、流产次数、分娩史、患慢性病、患妇科疾病、手术史、盆腔手术史、排便腹痛、排便腹胀等方面差异有统计学意义（均P〈0．05）。多因素logistic回归分析,妊娠次数（OR=1．29,95％CI=1．06～1．58）、患慢性病（OR=2．53,95％CI=1．38～4．62）、排便腹痛（OR=2．32,95％C1=1．10—4．91）是UUI危险因素。结论UUI影响因素复杂,有必要针对其危险因素针对性地开展UUI的预防和社区干预工作。