• 17
    Dec
  • OSTEOPOROSIS SCREENING IS UNJUSTIFIABLY: RESULTS

Preventive Medicine and Screening

The demographics of the patients included in the chart review are shown in Table 1. The mean age of the group was 69.6 years (range 53-94). Of the 252 women, only 11.5% had documentation of prior central bone densitometry (DEXA). Nearly 39% of the women were counseled about calcium and/or vitamin-D intake. Recommendations for hormone replacement therapy were documented for 54% of the women. In this same population, 74% of women had recently undergone screening mammography. The difference in the rates of screening for osteoporosis and statistically significant (p<0.001). There was no difference in the rates of DEXA or mammography between blacks and whites in this group (data not shown). For the African-American women, screening mammography was performed significantly more often than bone densitometry across all different age groups (Table 2).


Table 1. Characteristics of the 252 Subjects in the Retrospective Chart Review

Number

Percent

Race
African American

214

85.2%

Caucasian

35

14.0%

Other

3

0.8%
Documented Medical Problems
Heart disease*

75

29.8%

Hypertension

212

84.1%

Diabetes

91

36.1%

 

18

7.1%

Previous bone densitometry**   29

11.5%

Recent mammography**++

187

74.2%

Prescribing Habits
Estrogen recommended

137

54.4%

Estrogen use (ever)

79

31.3%

Calcium and/or Vitamin D recommended

97

38.5%

Calcium and/or Vitamin D use (ever)

69

27.4%

* Heart disease includes coronary artery disease, congestive heart failure, or arrhythmia.** Confirmed by radiology reports

++ Mammography within the last two years

Frequency of Osteopenia and Osteoporosis

The characteristics of the 128 women who underwent bone density testing are shown in Table 3. Their mean age was 67 (48-91), mean BMI was 31.4 (16.5-59.3), and mean age at menopause was 46 (21-57). Fifty-seven women (44.5%) had abnormal bone density by calcaneal measurement. Thirty-two women (25.0%) had measurements in the osteopenic range, while 25 (19.5%) were in the osteoporotic range. Caucasian women had a higher rate (53.3%) of abnormal bone density compared to African-American women (40.4%), but the difference was not statistically significant (p=0.35, Figure 1). canadian antibiotics

Figure 1. Frequency of Osteoporosis

Figure 1. Frequency of Osteoporosis and Osteopenia

Table 2. Osteoporosis and Breast Cancer Screening in 214 African-American Women

Age Groups

Overall (n=214)

<6S (n=76)

65-75 (n=75)

75+ (n=63)

Breast Cancer Mammography

156 (73%)

54 (71%) 60 (80%) 42 (67%)
Osteoporosis DEXA

23 (10.7%)

6 (7.9%) 11 (14.7%) 6 (9.5%)
p value

0.001

0.001 0.010 0.010

The findings were analyzed separately by both age and BMI. Subjects were divided into three age groups: 65 or less (n=50), 66-75 (n=45), and over 75 (n=33). The frequency of abnormal bone density (osteopenic and osteoporotic) increased with increasing age. In the youngest group, 36% of subjects had abnormal bone density compared to 42% in the middle age group and 61% in the oldest group (p=0.01). Figure 2a shows the bone density results by age groups in the cohort of African-American women. tadacip 20

Subjects were grouped by BMI (BMI) according to the WHO classification for obesity. In the African-American population evaluated, BMI was directly correlated with bone density (p<0.001, Figure 2b).

Table 3. Characteristics of Subjects Screened by Calcaneal DEXA

Number Percent

Race
African American

94

73.4%

Caucasian

33

25.8%

Native American

1

0.8%

High-school education or higher

77

60.2%

Tobacco use (ever)

62

48.4%

Family history of osteoporosis

14

10.9%

Estrogen use (ever)

29

22.7%

Six-Month Follow-Up

All 57 subjects with abnormal bone density results on peripheral testing were referred for central bone densitometry immediately after the evaluation, and a letter was sent to their primary provider recommending further testing. However, six months after the peripheral testing, only nine participants (16%)—all African American—had undergone central bone densitometry Central DEXA revealed osteoporosis in five subjects, osteopenia in three subjects, and normal bone density in one subject. The subject with a normal DEXA had a borderline score for osteopenia on peripheral testing.

Figure 2. Bone Density Results by Age Group

Figure 2. Bone Density Results by Age Group (2a) and BMI (2b) in African-American Women

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