Screening for Osteoporosis Risk Among Community-Dwelling Older Adults: A Scoping Review

Area of Science:

• Geriatric Medicine
• Rehabilitation Science
• Diagnostic Accuracy

Background:

• Osteoporosis (OP) poses significant health risks, necessitating effective screening by healthcare providers, including physical therapists.
• Current knowledge and guidance on OP screening tools suitable for physical therapy practice are limited.
• Identifying individuals at risk for OP is crucial for timely medical and rehabilitation interventions.

Purpose of the Study:

• To explore OP screening tools appropriate and feasible for physical therapy practice.
• To evaluate the effectiveness of OP screening tools by examining their clinimetric properties.

Main Methods:

• A systematic literature search was conducted across major databases (PubMed, PEDro, PsycINFO, CINAHL, Web of Science).
• Studies included populations aged 50+, with OP diagnosis, and screening tools within physical therapy scope, compared against bone densitometry or known OP diagnosis.
• Data on demographics, outcomes, cut-off values, and clinimetric properties were extracted and analyzed using likelihood ratios (+LR/-LR).

Main Results:

• Positive likelihood ratios (+LR) ranged from 0.15 to 20.21; FRAX and SOF demonstrated significant shifts in posttest probability.
• Negative likelihood ratios (-LR) ranged from 0.03 to 1.00; FRAX, Male Osteoporosis Risk Estimation Scores, OST, and Simple Calculated Osteoporosis Risk Estimation showed substantial shifts.
• Variability in cut-off scores and clinimetric properties across gender, age, and race/ethnicity was observed.

Conclusions:

• OST, FRAX, and SOF are recommended for use due to their moderate-to-large shifts in both +LR and -LR.
• A single, universally applicable OP screening tool recommendation is not feasible due to demographic variations.
• Future research should prioritize OP risk prediction in males and diverse racial/ethnic groups.