Sage Journals: Discover world-class research

Abstract

We tested associations between risk factors and bone mineral density in airways disease subjects, and developed a clinical screening tool to identify people who could benefit from bone mineral density testing. Subjects were recruited through hospital outpatients and pharmacies (Newcastle, n = 172). With survey refinement, we then tested a revised tool in a second sample (Adelaide, n = 317). Study factors included oral/inhaled corticosteroid use, asthma severity, respiratory admissions, physical activity, percent predicted forced expiratory volume in one second (FEVI), body mass index, and smoking history. Outcomes were bone mineral density of lumbar vertebra (L2–4) and total (or neck of) femur. Analysis was logistic regression with generation of a simple screening algorithm based upon coefficients. Scoring algorithm risk factors for T–score of – 2.0: age 68 = 10 points, bone mineral density <20 = 25, weight <60 kg = 20, 60–69 kg = 10, > 80 cigarette pack years = 15, low–level leisure activity = 5, area under receiver operator curve 0.83. For a cut–off score of 10, sensitivity was 91.2%, specificity 53.9%, positive and negative predictive values 52.3 and 91.7%, and 67.2% were correctly classified. In conclusions, our model has acceptable sensitivity, although limited specificity. Use of this tool may reduce unnecessary referrals for bone mineral density measurement.

Keywords

bone mineral density chronic obstructive airways disease osteoporosis screening

References

1. Randell A , Sambrook PN , Nguyen TV et al. Direct clinical and welfare costs of osteoporotic fractures in elderly men and women . Osteoporos Int 1995; 5: 427–432 .

2. Cumming RG , Klineberg R , Katelaris A . Cohort study of risk of institutionalisation after hip fracture . Aust N Z J Public Health 1996; 20: 579–582 .

3. Smith BJ , Phillips PJ , Heller RF . Asthma and chronic obstructive airway disease are associated with osteoporosis and fractures: A literature review . Respirology 1999; 4: 101–109 .

4. Wilson D , Wakefield M , Taylor A . South Australian Health Omnibus Survey . Health Promotion Journal of Australia 1992; 2: 47–49 .

5. Packe GE , Douglas JG , McDonald AF , Robins SP , Reid DM . Bone density in asthmatics taking high dose inhaled beclomethasone dipropionate . Thorax 1992; 47: 414–417 .

6. Cummings SR , Black DM , Nevitt MC et al. Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group . Lancet 1993; 341: 72–75 .

7. Jones KP , Bain DJG , Middleton M , Mullee MA . Correlates of asthma morbidity in primary care . BMJ 1992; 304: 361–364 .

8. Hilton S , Sibbald B , Anderson HR , Freeling P . Controlled evaluation of the effects of patient education on asthma morbidity in general practice . Lancet 1986; 1: 26–29 .

9. Avioli LV , Lindsay R . The female osteoporotic syndrome(s). In Avioli LV , Krane SM eds. Metabolic bone disease and clinically related disorders. Philadelphia: W.B. Saunders Co ., 1990: Chapter 12-12.

10.

10. Hens C , Bohning W Does COPD affect bone mineral content? Pneumologie 1990; 44: 204–205 .

11.

11. Law MR , Hackshaw AK . A meta–analysis of cigarette smoking, bone mineral density and risk of hip fracture: recognition of a major effect . BMJ 1997; 315: 841–846 .

12.

12. Pinnock CB , Martin AJ , Mylvaganam A . Milk intake and mucus production in asthmatic children . Proc Nutr Soc Aust 1989; 14: 131–131 .

13.

13. Lydick E , Cook K , Turpin J , Melton M , Stine R , Byrnes C . Development and validation of a simple questionnaire to facilitate identification of women likely to have low bone density . Am J Manag Care 1998; 4: 37–48 .

14.

14. Cadarette SM , Jaglal SB , Kreiger N , Mclsaac WJ , Darlington GA , Tu JV Development and validation of the Osteoporosis Risk Assessment Instrument to facilitate selection of women for bone densitometry . CMAJ 2000; 162: 1289–1294 .

15.

15. Henry DA , Gibson P , Cruichshank D et al. Non–prescription use of bronchodilator aerosols . Med J Aust 1992; 156: 68–68 .

16.

16. DPX–IQ Operator's Manual . Reference populations. Madison: Lunar Corporation , 1997a: I1–I12.

17.

17. British Thoracic Society . Guidelines for the Management of Chronic Obstructive Pulmonary Disease . Thorax 1997; 52: S2–S28 .

18.

18. Baecke JA , Burema J , Frijters JE . A short questionnaire for the measurement of habitual physical activity in epidemiological studies . Am J Clin Nutr 1982; 36: 936–942 .

19.

19. Cooper C , Wickham C , Coggon D . Sedentary work in middle life and fracture of the proximal femur . Br J Ind Med 1990; 47: 69–70 .

20.

20. Paffenbarger RS , Wing AL , Hyde RT . Physical activity as an index of heart attack risk in college alumi . Am J Epidemiol 1978; 108: 161–175 .

21.

21. LaPorte R , Kuller LH , Kupfer DJ , McPartland RJ , Mathews G , Casperen C . An objective measure of physical activity for epidemiological research . Am J Epidemiol 1979; 109: 158–168 .

22.

22. Angus RA , Sambrook PN , Pocock NA , Eisman JA . A simple method for assessing calcium intake in caucasian women . J Am Diet Assoc 1989; 89: 209–214 .

23.

23. Haas F , Bishop MC , Salazar–Schicchi J , Lieberman D , Axen KV Effect of milk ingestion on pulmonary function in healthy and asthmatic subjects . J Asthma 1991; 28: 349–355 .

24.

24. STATA [Stata Statistical Software]. StataCorp, Version Release 6.0. College Station, TX: Stata Corporation , 1999.

25.

25. Angus RM , Sambrook PN , Pocock NA , Eisman JA . Dietary intake and bone mineral density . Bone and Mineral 1988; 4: 265–271 .

26.

26. Von Muhlen D , Visby Lunde A , Barrett–Connor E , Bettencourt R . Evaluation of the simple calculated osteoporosis risk estimation (SCORE) in older Caucasian women: the Rancho Bemardo study . Osteoporos Int 1999; 10: 79–84 .

27.

27. Abbott TA, 3rd , Micha L , Manfredonia D , Schwartz EN , Berger ML . Efficient patient identification strategies for women with osteoporosis . J Clin Densitom 1999; 2: 223–230 .

Osteoporosis screening in people with airways disease

Abstract

Keywords

References