Test before you screen for bone mineral density
Quick survey points out candidates for screening
Mammograms, Pap smears, cholesterol tests, and blood sugar levels. Keeping track of which patients had the necessary screening tests can be a difficult proposition.
To make at least one screening guideline a little easier, Merck & Co pharmaceutical in Whitehouse Station, NJ, has developed a simple, six-question tool, called the Simple Calculated Osteoporosis Risk Estimation - SCORE. (See sample evaluation, p. 73.) SCORE signals whether patients need to be referred for bone mineral density testing.
The tool provides a starting point for discussions between doctors and patients about osteoporosis, says Christine Byrnes, MD, executive director of clinical development for Merck.
"The biggest risk factors [for osteoporosis] are just being post-menopausal and being female," she says.
But she notes that many physicians don't talk to their patients about osteoporosis until they suffer a fragility fracture.
"We need to change the way physicians think about the disease because this is preventable," Byrnes says.
SCORE was developed through questionnaires and clinical information on 1,279 post-menopausal women in 106 different physician practices. It correctly identified about 90% of women with low bone mass.1
Advanced age and body weight are major factors in the questionnaire, which includes previous fractures, race, a history of rheumatoid arthritis, and estrogen use.
"This is a filter. If a woman scores less than 6, you can feel comfortable that she doesn't have low bone mass," says Byrnes.
"It's not meant to replace physician assessment. It's a guide to help physicians know who in their post-menopausal population they should consider for bone mineral density testing."
Reference
1. Lydick E, Cook K, Turpin J, et al. Development and validation of a simple questionnaire to facilitate identification of women likely to have low bone density. Am J Man Care 1998; 4:37-48.
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