Diagnosis - Key Activities

Key Activities

Osteoporosis Canada [↓]
Women’s College Hospital [↓]

Osteoporosis Canada

Key activities:

Working jointly with researchers and professional health care associations, we are:

Helping develop standards for bone mineral density (BMD) measurement, accuracy and reporting across the country.
Promoting accreditation process for Dual Energy X-Ray Absorptiometry (DXA) sites and adoption of quality assurance protocols for DXA operation in partnership with Ontario Association of Radiologists (OAR).
Updating existing clinical guidelines for BMD testing.

Available resources and programs:

Clinical Practice Guidelines (2002).
BMD Facility Accreditation Program (jointly with OAR).

The Ontario Association of Radiologists (OAR) and Osteoporosis Canada (OC) have successfully launched the second phase of the Canadian Bone Mineral Densitometry (CBMD) Facility Accreditation pilot project. The first ten applications that applied under the OAR’s CBMD program have recently received their accreditation approval. Approximately ten other sites will be approved in the near future.

When the second phase of the pilot project is completed at the end of the year, there will be approximately 50 accredited BMD units in Ontario. This will make the CBMD the largest known BMD facility accreditation body in the world and solidify Ontario's role as the leader in BMD excellence.

Please click on the following link, to view the approved Centres of Bone Mineral Densitometry Excellence.

For additional information on the CBMD Facility Accreditation pilot project, please contact OAR.

Long-term outcomes:

Enhanced early detection and diagnosis of osteoporosis.

Links:

Women’s College Hospital

Key activities:

A thorough literature review was conducted to identify risk factors associated with low BMD in healthy women aged 40-60 years old. The risk factors examined included body weight, body mass index BMI), age, race, lifestyle factors (including physical activity, smoking, alcohol consumption, caffeine and calcium intake), reproductive factors (age of menarche, parity, duration of breastfeeding and years post-menopause) and family and personal history of prior fragility fracture after age 40 years. The literature review identified few studies that have focussed specifically on this subgroup of women. Low body weight was the only risk factor identified for low BMD.

From this literature review a study was designed with the purpose of developing a guideline, or clinical prediction rule, for BMD testing in healthy women approaching menopause (aged 40-60 years) that would be suitable for use in primary care.

Study participants were healthy women aged 40-60 years, referred for a first-ever BMD test at a large urban hospital. Risk factors for low BMD were assessed by a structured self-administered questionnaire. BMD at the lumbar spine, femoral neck and total hip were assessed with DXA. DXA was performed blind to risk assessment. Predictors of low BMD (T-score ≤ -2.0 at any site) were determined by multivariate regression. Several algorithms were compared to identify one with the highest sensitivity and acceptable specificity, to discriminate women with/without low BMD.

Among 628 participants, 69 (12.6%) had low BMD. The algorithm that recommended testing women who had 1 or more of the following 4 risk factors: weight ≤ 65 kg, low trauma fracture after age 40, age at menarche > 15 years, or physical inactivity during adolescence, had a sensitivity of 88.7% and a specificity of 41.3%. Using this algorithm as the decision rule, 38.4% of participants would not have been recommended for testing; among those not recommended, the likelihood of low BMD was 2.9%.

Long-term outcomes:

Implementation of a clinical prediction rule to assist in identification of the need for an initial BMD assessment in healthy perimenopausal women. The prediction rule recommends BMD testing in women who have 1 or more of the following 4 risk factors: weight ≤ 65 kg, low trauma fracture after age 40, age at menarche > 15 years, or physical inactivity during adolescence.

Links: