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Osteoporosis often remains undiagnosed until the patient turns up with a fracture. German researchers have developed a medical history questionnaire that they say can accurately predict which patients have osteoporosis.
Whether due to inadequate patient education or lack of insurance coverage, often the first sign that a patient has low bone muscle density is (sadly) a fracture. However, numerous risk factors are known to correlate with the development of osteoporosis. Trauma specialists in Germany decided to determine whether these could be used as accurate predictors of the presence of osteoporosis in the absence of clinical testing. The results are encouraging.
The team at the BG Trauma Centre in Ludwigshafen, Germany, studied 78 patients who presented with a metaphyseal fracture of the distal radius, proximal humerus or proximal femur, using both X-rays and dual energy X-ray absorptiometry (DXA) to assess the fracture. They also gave patients a standardized questionnaire developed according to recommendations of the German Society of Osteology, and measured 11 bone-specific metabolites.
The 10 most significant risk factors in the 21-item questionnaire, which includes questions about family and medical history as well as smoking and alcohol consumption, correlated strongly with DXA results indicating bone density loss (p=0.01). Other than a prior history of osteoporotic fractures, the most important risk factors the study found are age over 70, a history of smoking or heavy alcohol consumption, and height loss of more than 4 cm. Another highly significant factor was extended immobility or inactivity. The questionnaire proved more accurate than any combination of the metabolic measures.
As bone loss progresses silently, and the preventive window in which to reduce the risk of low-energy trauma is brief, the authors note, a "safe, simple and cost-effective instrument" to screen for the presence of osteoporosis would be valuable. Where their questionnaire points to the presence of osteoporosis, of course, the researchers advise followup with laboratory tests and DXA.
The study and the questionnaire are published in the open-access journal BMC Musculoskeletal Disorders.