Date Published: November 8, 2011
Publisher: SAGE-Hindawi Access to Research
Author(s): Bente Glintborg, Ulrik Hesse, Thomas Houe, Jensen Claus Munk, Jan Pødenphant, Bo Zerahn.
We aimed to determine whether the Emergency Department (ED) is a suitable entrance point for osteoporosis screening among fallers without concomitant fracture compared to referral from general practice. Furthermore, to identify factors associated with osteoporosis among fallers.
Methods. Patients aged 50–80 years sustaining a low-energy fall without fracture were identified from an ED (n = 199). Patients answered a questionnaire on risk factors and underwent osteodensitometry. Data was compared to a group of patients routinely referred to osteodensitometry from general practice (n = 201). Results. Among the 199 included fallers, 41 (21%) had osteoporosis. Among these, 35 (85%) reported either previous fracture or reduced body height (>3 cm). These two risk factors were more frequent among fallers with osteoporosis compared to fallers with normal bone mineral density or osteopenia (previous fracture P = .044, height reduction P = .0016). The osteoporosis frequency among fallers from ED did not differ from a similarly aged patient-group referred from general practice (P = .34).
Conclusion. Osteodensitometry should be considered among fallers without fracture presenting in the ED, especially if the patient has a prior fracture or declined body height. Since fallers generally have higher fracture risk, the ED might serve as an additional entrance to osteodensitometry compared to referral from primary care.
Osteoporosis is a frequent but widely underdiagnosed condition [1–4]. The frequency of osteoporosis is higher among women and increases steadily with age. Among perimenopausal women, the frequency of osteoporosis is estimated to be 7%–15% [1, 5–7], whereas 30%–40% of all postmenopausal women and 18%–20% of men aged >50 years have osteoporosis [1, 8, 9]. Falling increases the risk of fracture in the osteoporotic individual [10, 11]. The risk of falling increases with age and is more frequent among women than men . One third of all individuals aged 65+ years are susceptible to at least one annual falling episode, and among the 80+ year-old individuals the risk of falling increases to 50% . Previous falls are a strong predictor of new falls , and the frequency of fractures associated with falls among the elderly is 6% of which one in six will be a hip fracture .
The study was performed at a Danish university hospital (Herlev Hospital) from January 2004 to December 2005. The Local Ethics Committee accepted the study protocol (KA 03097, November 2003), and the study was performed in agreement with the Helsinki declaration. In 2005, the ED at Herlev Hospital had a local catchment area of approximately 200000 citizens and treated 100 surgical or medical patients daily. On average, 60% of treated patients were 50+ years old, and one third of contacts involved fractures, sprains, bruises, lacerations, and so forth.
Demographic data are reported using descriptive statistics and ANOVA with Bonferroni correction for comparison between normal, osteopenia, and osteoporosis for each gender. Chi-square tests (categorical data) and independent-sample t-tests (continuous data) were used for comparison of independent groups of data except when comparing T-scores for men in various age groups between fallers and patients referred from general practice, where a Mann-Whitney U test was used due to low numbers in one of the groups.
In this study, 21% of women and of men had unidentified osteoporosis if they were aged 50–80 years and presented in an ED after a fall without current bone fracture. Thus, the prevalence of osteoporosis among ED patients was not significantly different from that of patients referred from primary care in our catchment area. It therefore appears to be as efficient to screen nonfractured fallers presenting in the ED as compared to a population of patients referred from general practice. Moreover, the osteoporotic patients identified from the ED were more frequently normal weight men compared to mainly low-weight women referred from general practitioners. Relatively few men were referred for BMD measurements from general practice (13% versus 37% in the group of fallers), but there was a higher percentage of men with osteoporosis among those referred from general practitioners (37%) compared to the male fallers included from the ED (21%). Thus, screening patients from the ED apparently facilitated the identification of osteoporosis among a group of patients which had a different gender distribution, body height, and body weight compared to patients referred from general practitioners.