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Does this woman have osteoporosis?

Publication ,  Journal Article
Green, AD; Colón-Emeric, CS; Bastian, L; Drake, MT; Lyles, KW
Published in: JAMA
December 15, 2004

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 count less 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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Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

December 15, 2004

Volume

292

Issue

23

Start / End Page

2890 / 2900

Location

United States

Related Subject Headings

  • Spinal Fractures
  • Risk Assessment
  • Physical Examination
  • Osteoporosis
  • Middle Aged
  • Humans
  • General & Internal Medicine
  • Female
  • Bone Diseases, Metabolic
  • Aged
 

Citation

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Green, A. D., Colón-Emeric, C. S., Bastian, L., Drake, M. T., & Lyles, K. W. (2004). Does this woman have osteoporosis? JAMA, 292(23), 2890–2900. https://doi.org/10.1001/jama.292.23.2890
Green, Amanda D., Cathleen S. Colón-Emeric, Lori Bastian, Matthew T. Drake, and Kenneth W. Lyles. “Does this woman have osteoporosis?JAMA 292, no. 23 (December 15, 2004): 2890–2900. https://doi.org/10.1001/jama.292.23.2890.
Green AD, Colón-Emeric CS, Bastian L, Drake MT, Lyles KW. Does this woman have osteoporosis? JAMA. 2004 Dec 15;292(23):2890–900.
Green, Amanda D., et al. “Does this woman have osteoporosis?JAMA, vol. 292, no. 23, Dec. 2004, pp. 2890–900. Pubmed, doi:10.1001/jama.292.23.2890.
Green AD, Colón-Emeric CS, Bastian L, Drake MT, Lyles KW. Does this woman have osteoporosis? JAMA. 2004 Dec 15;292(23):2890–2900.
Journal cover image

Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

December 15, 2004

Volume

292

Issue

23

Start / End Page

2890 / 2900

Location

United States

Related Subject Headings

  • Spinal Fractures
  • Risk Assessment
  • Physical Examination
  • Osteoporosis
  • Middle Aged
  • Humans
  • General & Internal Medicine
  • Female
  • Bone Diseases, Metabolic
  • Aged