Led by Susan Greenspan, M.D., professor of medicine at Pitt, the study, published in this month’s Journal of the American Geriatrics Society, sought to identify nursing home patients who would benefit from pharmacologic treatment of osteoporosis, which could decrease their risk for bone fractures. Osteoporosis is a disease that causes bones to become weak and break easily.
“Osteoporosis in the frail elderly can have devastating consequences, but we have yet to perfect a system for identifying those patients who would benefit most from the treatment,” Dr. Greenspan said.
The researchers evaluated a variety of osteoporosis screening strategies in more than 200 women residing in 11 long-term care facilities in the Pittsburgh area. Screening measures included history of bone fracture, bone mineral density by standard Dexa scanning, the fracture risk assessment tool (FRAX) with body mass index (BMI), FRAX with femoral neck bone density, and heel ultrasound.
The study found that depending on the screening strategy used, identification of treatment eligibility varied from 17 percent for clinical fracture to 98 percent for FRAX with BMI. Also, three-quarters of vertebral fractures were “silent,” meaning they caused no symptoms, and were identified only through X-ray or special screening scans.
“This is worrisome because many physicians rely on bone density screening, but that approach missed half the women with vertebral fractures who would be candidates for osteoporosis treatment,” Dr. Greenspan said. “Still, some form of screening for vertebral fractures is appropriate because treatment could prevent more osteoporosis damage and future fractures.”
The researchers concluded that a reasonable clinical approach would be to consider treatment for those with clinical fractures of the hip or spine, radiologic evidence for a vertebral fracture or osteoporosis by bone mineral density classification.
The study’s authors say the findings are important because the number of U.S. residents over age 85 is rapidly growing and nearly 2 million people live in long-term care facilities across the country. Nursing home residents who have fractured a bone are hospitalized more than 15 times as often as those without a fracture and have a higher mortality rate the authors said.
Collaborators on the study were Subashan Perera, Ph.D.; David Nace, M.D.; Kimberly S. Zukowski, R.N.; Mary Anne Ferchak, B.S.N.; Carroll J. Lee, B.S.N.; Smita Nayak, M.D.; and Neil M. Resnick, M.D., all from the University of Pittsburgh.
Funding for the study was provided by the National Institutes of Health and a private family donation.