Background: Bone mass density (BMD) test is used for diagnosing osteoporosis and identifying patients at high risk for fractures. Hip fractures are one of the possible negative outcomes of osteoporosis. Previous studies have examined demographic variations in osteoporotic hip fractures in ethnic groups, but the predictive value of BMD for future fracture is unknown.
Objective: To determine whether a BMD test is associated with a lower risk of first hip fractures in patients aged 50 years and older in various demographic populations in Israel.
Methods: We used a retrospective study of members of Clalit Health-Services aged 50 years and older. We stratified patients by those who did and did not have a BMD during 1.1.2008.A multivariable logistic model was used to assess factors associated with having the BMD test, and propensity scores for performing the BMD test were generated. Cox proportional-hazards regression was used to examine the association between having a BMD test and the future risk of first hip fractures, in quintiles of the propensity score, up until 31/12/2014. We controlled for demographic variables and known risks factors for fractures in the model.
Results: Only in the population with the highest propensity for performing a BMD (women aged 65 and older, high socioeconomic status, Jewish ethnicity, treated with steroid medication and having osteoporosis-related diseases) there was an association between having a BMD test and a lower risk for first hip osteoporotic fracture during the 7-year follow-up, which was by 33% (P<0.001). Among this sub-population, the association between a BMD test and future hip fracture was the most protective among Arabs (88%, P=0.018), women (46%, P=0.011) and patients aged 65+(50%, P<0.001).
Conclusion: In Israel, BMD test is an effective screening tool to lower the risk for osteoporotic hip fractures mainly among high-risk sub-populations. Testing rates should be improved in marginalized populations.
14 May 2016 - 17 May 2016