DEXA absorptiometry alone may not identify patients at risk for fragility fracture
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Use of DEXA scan alone may not adequately identify patients with hip fracture at risk for fragility fracture, according to results.
Kenneth A. Egol, MD, FAAOS, and colleagues identified 80 patients with hip fractures who were referred for bone health evaluation as part of the Own the Bone program at NYU Langone Health and received a DEXA scan within 2 weeks of hip fracture. Researchers categorized patients into osteoporotic (n=38) and non-osteoporotic (n=42) cohorts, and evaluated them for age, BMI, baseline ambulatory status, assistive device use prior to hip fracture, Charlson Comorbidity Index (CCI) and marital status.
Results showed an association between older patients and lower BMI with a positive DEXA and diagnosis of osteoporosis. However, researchers found no association with CCI, baseline ambulatory ability, use of assistive device prior to hip fracture, sex and marital status. When controlled for age and CCI, binomial regression showed BMI was predictive of a diagnosis of osteoporosis, with the odds of having osteoporosis increasing by 1.12 times with each 1 kg/m2 BMI decrease. Further sub-analysis showed osteoporosis was less likely among patients with a BMI of 30 kg/m2 to 39.9 kg/m2 vs. patients with a BMI of 18.5 kg/m2 to 29.9 kg/m2.
“Our data suggest that, of all hip fracture patients who presented over a 2-year period, less than half would have been considered osteoporotic by T-score. Thus, DEXA scan results alone appear inadequate to identify patients who are at risk for a fragility fracture,” Egol, the Joseph E. Milgram professor of orthopedic surgery and chief of the division of orthopedic trauma at NYU Langone Health, told Healio Orthopedics. “Furthermore, those with lower BMIs were more likely to carry the diagnosis of osteoporosis than patients with higher BMIs. The fracture risk assessment tool (FRAX), which takes into account clinical factors as well as bone mineral density levels, may be a better risk assessment.” – by Casey Tingle
Reference:
Kelly EA, et al. ePaper 004. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2020 (meeting canceled).
Disclosure: Egol reports he receives research support from Acumed LLC and Synthes; receives IP royalties and is a paid consultant for Exactech Inc.; is a board or committee member for Orthopaedic Trauma Association; is an unpaid consultant for Polypid; receives publishing royalties, financial or material support from SLACK Incorporated and Wolters Kluwer Health – Lippincott Williams & Wilkins; and is a paid presenter or speaker for Smith & Nephew.