Osteoporosis and Metabolic Bone Disease [127–142]

• Published in: Rheumatology (Oxford, England) England), 2010-04, Vol.49 (suppl-1), p.i80-i86
• Main Authors: El Miedany, Yasser, El Gaafary, Maha, Youssef, Sally, Toth, Mathias, Weightman, Jessica, Kelly, Madeleine, Johnston, Emma, Stone, Amanda, Harrison, Patricia, Bartholomew, Peter, Kelly, Clive, Vagadia, Vipul, Tuck, Stephen, Al-Shakarchi, Israa, Louise Dolan, Ann, Bridges, Matt J., Ruddick, Sheila, Bracewell, Claire, Wright, David, Aspray, Terence, Hynes, Gareth M., Jameson, Karen, Aihie Sayer, Avan, Cooper, Cyrus, Dennison, Elaine, Robinson, Sian, Tull, Thomas J., Fisher, Ben A., Jenabzadeh, Reza, Cobb, Justin P., Abraham, Sonya, Harvey, Nick, Cheah, Jonathan, Stacpoole, Sybil, Heaney, Dominic, Duncan, John, Roshandel, Delnaz, Holliday, Kate, Pye, Stephen R., Boonen, Steven, Borghs, Herman, Vanderschueren, Dirk, Adams, Judith E., Ward, Kate A., Finn, Joseph D., Huhtaniemi, Ilpo T., Silman, Alan J., Wu, Frederick C., Thomson, Wendy, O’Neill, Terence W., White, Susanna, Shaw, Simon, Short, Charlotte, Gilleece, Yvonne, Fisher, Martin, Walker-Bone, Karen, Narshi, Chetan B., Martin, Rhodri, Mitchell, Karen, Keen, Richard, Alhambra, Daniel Prieto, Azagra, Rafael, Duro, Gloria Encabo, Aguye, Amada, Zwart, Marta, Javaid, Kassim M.
• Format: Article
• Language: English
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/keq723

Background: To assess the validity of a new referral model for DXA scanning, its impact on patients’ management and whether it meets the targets of the osteoporosis and falls service. Methods: The referral form was developed, including 3 main components: 1. Risk factors for osteoporosis (6 factors). 2. the 8 risk factors identified in FRAX (WHO fracture risk assessment tool) and 3. Risk factors for falls (5 factors). Special icons were used to give clinical hints for vertebral morphometry and tilting table assessment. The model was set up with only ticking the appropriate boxes is required. Validation of the model was done through: 1. comparing the referral form to the medical notes and the patients’ answers to a pre-scanning questionnaire. 2. Each patient was assessed and management plan (guided by the national guidelines) was considered blindly twice based on the data available in the new referral form in comparison to the old referral form. DXA measurements were then analyzed in relation to self-reported incidence of falls, fractures and the calculated 10-years fracture probability (using FRAX). Results: A total of 264 postmenopausal women (mean age, 68.6 + 4.73 years) were included in this work. Osteoporosis was found in 113/264 (42.8%) of the patients whereas osteopenia prevalence was 32.1% (86/264). 34.5% (91/264) of the patients had a past history of low trauma fracture and 21.6% (57/264) reported 1 or more falls during the preceding year. Patients treated based on the osteoporosis-falls-FRAX composite were significantly higher (r = 0.635) than those treated based on the old referral form. Most of these patients were suffering from secondary osteoporosis and their DXA scan revealed borderline osteoporosis/osteopenia. Adjusted risk for age, BMI, bone density and 10-year fracture probability in the past 12 months in patients who reported a fall was 6.0 (95% CI, 3.2-10.5, P