Does this woman have osteoporosis?

Amanda D. Green, Cathleen S. Colón-Emeric, Lori Bastian, Matthew M Drake, Kenneth W. Lyles

Research output: Contribution to journalArticle

68 Citations (Scopus)

Abstract

Context: Although recent US Preventive Services Task Force guidelines recommend bone densitometry for all women older than 65 years, identifying younger women at increased risk for osteoporosis and women with occult vertebral fractures remains a clinical challenge. We investigated whether physical signs are useful as a screening tool either for early referral to bone densitometry or for occult spinal fractures. Objective: To review the accuracy and precision of physical examination findings for the diagnosis of osteopenia, osteoporosis, or spinal fracture. Data Sources: We conducted a MEDLINE search for articles published from 1966 through August 2004, manually reviewed bibliographies, consulted 4 clinical skills textbooks, and contacted experts in the field. Study Selection: Studies were included if they contained adequate original data on the accuracy or precision of physical examination for diagnosing osteopenia, osteoporosis, or spinal fracture. Two authors screened abstracts found by the search. Fourteen of 191 full articles reviewed met inclusion criteria. Data Extraction: Two authors independently abstracted data from the included studies. Disagreements were resolved by discussion. Data Synthesis: No single maneuver is sufficient to rule in or rule out osteoporosis or spinal fracture without further testing. The following yielded the greatest positive likelihood ratios (LR+): weight less than 51 kg, LR+, 7.3 (95% confidence interval [CI], 5.0-10.8); tooth countless than 20, LR+, 3.4 (95% CI, 1.4-8.0); rib-pelvis distance less than 2 finger breadths, LR+, 3.8 (95% CI, 2.9-5.1); wall-occiput distance greater than 0 cm, LR+, 4.6 (95% CI, 2.9-7.3), and self-reported humped back, LR+, 3.0 (95% CI, 2.2-4.1). Conclusions: In patients who do not meet current bone mineral density screening recommendations, several convenient examination maneuvers, especially low weight, can significantly change the pretest probability of osteoporosis and suggest the need for earlier screening. Wall-occiput distance greater than 0 cm and rib-pelvis distance less than 2 fingerbreadths suggest the presence of occult spinal fracture.

Original languageEnglish (US)
Pages (from-to)2890-2900
Number of pages11
JournalJournal of the American Medical Association
Volume292
Issue number23
DOIs
StatePublished - Dec 15 2004
Externally publishedYes

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Spinal Fractures
Osteoporosis
Closed Fractures
Confidence Intervals
Densitometry
Metabolic Bone Diseases
Ribs
Pelvis
Physical Examination
Weights and Measures
Bone and Bones
Clinical Competence
Textbooks
Information Storage and Retrieval
Bibliography
Advisory Committees
MEDLINE
Bone Density
Fingers
Tooth

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Green, A. D., Colón-Emeric, C. S., Bastian, L., Drake, M. M., & Lyles, K. W. (2004). Does this woman have osteoporosis? Journal of the American Medical Association, 292(23), 2890-2900. https://doi.org/10.1001/jama.292.23.2890

Does this woman have osteoporosis? / Green, Amanda D.; Colón-Emeric, Cathleen S.; Bastian, Lori; Drake, Matthew M; Lyles, Kenneth W.

In: Journal of the American Medical Association, Vol. 292, No. 23, 15.12.2004, p. 2890-2900.

Research output: Contribution to journalArticle

Green, AD, Colón-Emeric, CS, Bastian, L, Drake, MM & Lyles, KW 2004, 'Does this woman have osteoporosis?', Journal of the American Medical Association, vol. 292, no. 23, pp. 2890-2900. https://doi.org/10.1001/jama.292.23.2890
Green, Amanda D. ; Colón-Emeric, Cathleen S. ; Bastian, Lori ; Drake, Matthew M ; Lyles, Kenneth W. / Does this woman have osteoporosis?. In: Journal of the American Medical Association. 2004 ; Vol. 292, No. 23. pp. 2890-2900.
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abstract = "Context: Although recent US Preventive Services Task Force guidelines recommend bone densitometry for all women older than 65 years, identifying younger women at increased risk for osteoporosis and women with occult vertebral fractures remains a clinical challenge. We investigated whether physical signs are useful as a screening tool either for early referral to bone densitometry or for occult spinal fractures. Objective: To review the accuracy and precision of physical examination findings for the diagnosis of osteopenia, osteoporosis, or spinal fracture. Data Sources: We conducted a MEDLINE search for articles published from 1966 through August 2004, manually reviewed bibliographies, consulted 4 clinical skills textbooks, and contacted experts in the field. Study Selection: Studies were included if they contained adequate original data on the accuracy or precision of physical examination for diagnosing osteopenia, osteoporosis, or spinal fracture. Two authors screened abstracts found by the search. Fourteen of 191 full articles reviewed met inclusion criteria. Data Extraction: Two authors independently abstracted data from the included studies. Disagreements were resolved by discussion. Data Synthesis: No single maneuver is sufficient to rule in or rule out osteoporosis or spinal fracture without further testing. The following yielded the greatest positive likelihood ratios (LR+): weight less than 51 kg, LR+, 7.3 (95{\%} confidence interval [CI], 5.0-10.8); tooth countless than 20, LR+, 3.4 (95{\%} CI, 1.4-8.0); rib-pelvis distance less than 2 finger breadths, LR+, 3.8 (95{\%} CI, 2.9-5.1); wall-occiput distance greater than 0 cm, LR+, 4.6 (95{\%} CI, 2.9-7.3), and self-reported humped back, LR+, 3.0 (95{\%} CI, 2.2-4.1). Conclusions: In patients who do not meet current bone mineral density screening recommendations, several convenient examination maneuvers, especially low weight, can significantly change the pretest probability of osteoporosis and suggest the need for earlier screening. Wall-occiput distance greater than 0 cm and rib-pelvis distance less than 2 fingerbreadths suggest the presence of occult spinal fracture.",
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