Simplifying screening for osteoporosis in Australian primary care: PROSPECT Study

Davis SR, Kirby C, Weekes A, Lanzafame A, Piterman L. Simplifying screening for osteoporosis in Australian primary care: the Prospective Screening for Osteoporosis; Australian Primary Care Evaluation of Clinical Tests (PROSPECT) study. Menopause. 2011 Jan;18(1):53-9.

This study was conducted by the Women's Health Program and School of Primary Care of Monash University in conjunction with Servier Laboratories Australia.

Although it is recommended that women over the age of 65 have screening for osteoporosis and in Australia the cost of the screening for women over the age of 70 is covered by Medicare, only a minority of women of this age are in fact screened. Screening is usually in the form of a bone density test (DEXA) and some women will be referred to have a plain x-ray of the spine by their doctor to look for the presence of a fracture.

The aim of this study was to see if we could identify characteristics of women 70 years or older who had very low bone density (osteoporosis) or a vertebral fracture on x-ray and use these characteristics to develop a screening tool such that general practitioners could identify high risk women and refer them for investigation.

276 general practitioners from across Australia recruited 2466 women aged 70 years and over who had no previous diagnosis of osteoporosis to participate in this community based cross-sectional study.

Findings

  • one in five of the women who participated in the study had osteoporosis
  • one in four of the women who participated in the study had a previously undiagnosed vertebral fracture and found on plain x-ray
  • only 7% of the women had both osteoporosis and a plain x-ray fracture

Therefore, by only screening older women with DEXA would mean that a substantial number of women with factures who should be treated would never be diagnosed (18% of women 70 years and over).

Screening of women 70 years and older to identify the women who should be treated to prevent a future fracture requires a combination of both DEXA and plan x-ray

From this study we have developed the PROSPECT tool to help general practitioners identify the women 70+ years who are at the greatest risk of future fracture and therefore should be referred for radiological screening. This is now available to general practitioners across Australia.