An audit: A silent disease-Osteoporosis

S. Chokalingam¹, D. Sathish Kumar², P. R. Ramasamy³

¹Senior Consultant, Department of orthopaedics, Kauvery Hospital, Trichy

²DNB PG, Department of orthopaedics, Kauvery Hospital, Trichy

³HOD, Department of orthopaedics, Kauvery Hospital, Trichy

Editor’s Note: This paper is an adaptation of a presentation made at a clinical meeting

Introduction

Osteoporosis: The Silent Disease

A silent disease – does not have any typical symptoms and you may not even know you have the disease until you break a bone. Characterised by low bone mass and micro architectural deterioration of bone tissue, leading to enhanced bone fragility and fracture risk.

The menace of Osteoporosis

Fragility fractures as we grow older affects spine. hip, distal femur, wrist, shoulder

The chances of a second fracture is high once there is one fracture

Can we diagnose this silent disease prior to it hitting us with a fracture?

Dual energy X-ray absorptiometry:

Most effective (gold standard) technique used to measure Bone Mineral Density (BMD).
Measures the density or thickness of bones and amount of calcium in the specific area of bone.
DEXA Scan at Kauvery is only one such facility in Trichy
It was installed at Cantonment in the year – 2021
It has now been shifted to Maa Kauvery

Interpretation

T-score: compare results to a healthy young adult.

Z-score: compare results to a person of the same gender and age as yourself.

Normal bone density: > -1.0
Osteopenia: -1 to -2.5
Osteoporosis: < -2.5

Materials and Methods

Who should undergo?

All women above the age of 65 and males over 70 years.
Estrogen deficiency
Individuals who develop wrist, hip, spine or proximal humerus fractures with minimal or no trauma.
Medications affecting the bone metabolism like glucocorticoids, anti epileptics, chronic heparin or warfarin therapy.
Patients receiving radiation or chemotherapy for malignancies.
Chronic distress patients

Limitations of DEXA scan

It cannot predict who will experience a fracture but can provide a relative risk and it is used to determine whether treatment is required

FRAX tool should be used to predict fracture risk along with the DEXA data

Results and Discussion

We audited the patients who underwent DEXA scan at our hospital.

Totally, there was 485 patients

Males = 93
Females = 392

Normal>>>Osteoporosis >> osteopenia

Patients who had DEXA scan done

Inference

Aged 40 and above has been the age pattern of population undergoing DEXA Scan

50 to 80 is the major group undergoing DEXA Scan

24 patients above the age of 80 had DEXA scan! Need to study why?

Gender distribution of those who had scans

19% who had Scans were males i.e one in five scanned

81% who had scans were females I.e four out of scanned

Gender vs Osteopenia and Osteoporosis

Females and Osteoporosis

Females at different age and osteoporosis

147 out of 392 were diagnosed to have Osteoporosis. i.e. 37.5% were diseased.

Most of the females had osteoporosis above the age of 50

Males and Osteoporosis

Males at different age with osteoporosis

13 out of 93 males were diagnosed with osteoporosis, i.e. 14% had osteoporosis

However, the numbers are small to make valid conclusion

Inference

Males and DEXA scan

Males had younger group with osteoporosis, though numbers are small
13 males out of 93 scanned had Osteoporosis
80 out of 93 males scanned did not have osteoporosis
33 out of 93 males scanned were 50 and younger! Need to study why!
25% of those who had DEXA scan had normal values
42% of those who had DEXA scan had osteopenia
33% of those who had DEXA scan had osteoporosis I.e one third
Osteopenia was more common than Osteoporosis

Summary of the findings in the audit and the scope for improvement

Females are referred more and appropriately ? located at Maa Kauvery
(Orthopaedics, Physicians treat large number of females above the age of 60)
33 out of Males below the age of 50 had DEXA Scan, ? Appropriateness
Reason for the DEXA scan is not available, need referral reason documentation
Female health check up for over 65 can include DEXA scan routinely
Information leaflets on osteoporosis and DEXA scan should be made available
With wider awareness, more population can be directed to DEXA for prevention of fractures
Implementation of FRAX tool to predict fracture risk

Conclusion

Patient education, advising DEXA to appropriate patients
All fragility fractures should have a follow-up DEXA scan to prevent further fractures
Future study will be possible if reason for referral for DEXA scan is captured
Including the DEXA as mandatory investigation in the master health check-up.
FRAX tool addition to reporting will be more beneficial than DEXA alone.

Dr. S. Chockalingam
Senior Orthopaedic Consultant and Surgeon

Dr. P. R. Ramasamy
HOD and Senior Consultant

An audit: A silent disease-Osteoporosis

An audit: A silent disease-Osteoporosis

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