Use of decision rules for osteoporosis prevention and treatment: implications for nurse practitioners

PURPOSE: To describe the current literature regarding the benefits of bone mineral density (BMD) screening and to discuss clinical decision rules for BMD screening. DATA SOURCES: Extensive review of the scientific literature regarding osteoporosis, BMD screening, and current clinical decision rules. CONCLUSIONS: Osteoporosis is a disease characterized by deterioration of bone and increased susceptibility to fractures, crippling, and disfigurement. BMD testing is the best predictor for osteoporosis and associated fractures; however, routine global BMD testing is cost-prohibitive. A need exists for a selective and practical clinical decision rule for referral for testing. IMPLICATIONS FOR PRACTICE: Several effective clinical decision rules are presented, and their uses and applications are described. The osteoporosis self-assessment tool is recommended by the authors because of its predictive power and ease of use.