FRAX or Fiction: Determining Optimal Screening Strategies for Treatment of Osteoporosis in Residents in Long-Term Care Facilities

Authors


Address correspondence to Susan L. Greenspan, Professor of Medicine, University of Pittsburgh, Pittsburgh, PA 15213. E-mail: greenspn@pitt.edu

Abstract

Objectives

To examine screening strategies for osteoporosis and fractures for treatment of long-term care residents.

Design

Cross-sectional analysis to examine screening strategies for treatment.

Setting

Assisted living and skilled care facilities.

Participants

Two hundred two frail women aged 65 and older (mean 85), excluding those receiving bisphosphonates.

Measurements

Clinical fractures of the hip or spine (Clin Fx); Clin Fx or bone mineral density (BMD); Clin Fx, BMD, or vertebral fractures (VF) assessed according to dual-energy X-ray absorptiometry-based vertebral fracture assessments; fracture risk algorithm using femoral neck BMD (FRAX-FN); fracture risk algorithm using body mass index (FRAX-BMI); or Clin Fx or heel ultrasound (heel US).

Results

Treatment eligibility ranged from 17% (Clin Fx) to 98% (FRAX-BMI). VFs were found in 47%, 74% of which were silent. Criteria with Clin Fx, BMD, or VF identified 73% of study participants for treatment. FRAX-FN suggested treatment in 81% but would have missed approximately 10% of individuals with silent VFs. Clin Fx or heel US suggested that 39% of participants were eligible for treatment.

Conclusion

Long-term care residents eligible for osteoporosis treatment ranged from fewer than 20% to roughly all residents depending on screening criteria. VFs are common and identify a subset of residents missed by conventional BMD scans or FRAX-FN. A reasonable clinical approach could consider treatment for those with Clin Fx of the hip or spine, radiological evidence of a VF, or osteoporosis according to BMD classification. Prospective studies are needed to determine optimal screening strategies for treatment in this cohort.

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