Two Clinical Decision-Making Tools Are Somewhat Better Than Guidelines In Identifying High-Risk Women.(measurement of bone mineral density)

2001 AUG 9 - (NewsRx Network) -- Two clinical decision rules to select women for bone mineral density (BMD) testing appear somewhat better than current U.S. practice guidelines in identifying high-risk patients for BMD testing, according to an article in the July 4, 2001, issue of the Journal of the American Medical Association.

Suzanne M. Cadarette, MSc, of the University of Toronto, Ontario, and colleagues assessed the diagnostic properties of four decision rules - Simple Calculated Osteoporosis Risk Estimation (SCORE), Osteoporosis Risk Assessment Instrument (ORAI), Age, Body Size, No Estrogen (ABONE), and body weight less than 70 kilograms/154 pounds (weight criterion) - for selecting women for dual-energy x-ray absorptiometry (DXA) testing and to compare results with recommendations made in the National Osteoporosis Foundation (NOF) practice guidelines.

Clinical decision rules are evidence-based tools that can help reduce uncertainty in medical practice by implementing clear criteria for the use of major clinical findings. They range from the very simple, being based on weight alone, to more complex selection schemes requiring the assessment of many risk factors.

Cadarette and coauthors note that identification of women with low BMD is an important strategy for reducing the incidence of osteoporotic fractures. However, screening all women is not recommended. They indicate that DXA is accepted as the most accurate clinical method for identifying women with low BMD. DXA systems use two x-ray beams with different levels of energy, and after subtraction of soft-tissue absorption, the absorption of each beam by bone is used to calculate the BMD value.

The authors analyzed data from the Canadian Multicentre Osteoporosis Study, a population-based community sample, collected from nine study centers across Canada between February 1996 and September 1997. The study ...