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¿Tiene esta mujer osteoporosis?
Amanda D Green1, Cathleen S Colón-Emeric, Lori Bastian
1Ambulatory Care Service, Durham Veterans Affairs Medical Center, Durham, NC, USA.
JAMA
|December 16, 2004
Resumen
Los hallazgos del examen físico, como el bajo peso, pueden ayudar a identificar a las mujeres en riesgo de osteoporosis, lo que sugiere una detección temprana. Los signos específicos, como la distancia entre la pared y el occipito, pueden indicar fracturas espinales ocultas.
Área de la Ciencia:
- El cribado de la osteoporosis.
- Precisión en el diagnóstico.
- Examen físico El examen físico.
Sus antecedentes:
- Las directrices actuales recomiendan la densitometría ósea para mujeres mayores de 65 años.
- Identificar a las mujeres más jóvenes en riesgo de osteoporosis y fracturas vertebrales ocultas sigue siendo un desafío.
Objetivo del estudio:
- Evaluar la exactitud y precisión de los hallazgos del examen físico para el diagnóstico de osteopenia, osteoporosis o fractura de columna vertebral.
Principales métodos:
- Realizó una búsqueda exhaustiva de MEDLINE (1966-2004), revisó bibliografías, consultó libros de texto y se puso en contacto con expertos.
- Se incluyeron estudios con datos originales sobre la precisión del examen físico para el diagnóstico de osteoporosis o fractura de columna vertebral.
- 14 de los 191 artículos revisados cumplieron con los criterios de inclusión después del cribado.
Principales resultados:
- Ninguna sola maniobra física puede diagnosticar definitivamente la osteoporosis o la fractura de la columna vertebral.
- Los ratios de probabilidad positiva (LR +) fueron más altos para: peso < 51 kg (LR +, 7.3), distancia entre la pared y el occiputo > 0 cm (LR +, 4.6) y distancia entre la costilla y la pelvis < 2 dedos (LR +, 3.8).
- Otros hallazgos significativos incluyeron el recuento de dientes < 20 (LR +, 3.4) y autoinformado jorobado hacia atrás (LR +, 3.0).
Conclusiones:
- Varias maniobras de examen físico, particularmente bajo peso corporal, pueden aumentar la probabilidad de osteoporosis en pacientes que no cumplen con los criterios de detección actuales.
- Una distancia entre la pared y el occiputo superior a 0 cm y una distancia entre la costilla y la pelvis inferior a 2 dedos sugiere la presencia de fracturas espinales ocultas.
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