Mirzaei Alireza, Zabihiyeganeh Mozhdeh, Tabrizian Pouria, Heydari Pegah, Farajimoghadam Fahimeh
Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA.
BMC Musculoskelet Disord. 2025 Jul 28;26(1):719. doi: 10.1186/s12891-025-08928-x.
Despite the availability of effective interventions, a substantial number of osteoporosis patients remain underdiagnosed and undertreated, particularly those under 65 years of age. This study aimed to assess the frequency of osteoporotic fractures in patients under 65 years referred to a Fracture Liaison Service (FLS) clinic and to evaluate the applicability of current Bone Mineral Density (BMD) testing guidelines.
We conducted a retrospective review of the medical profiles of patients enrolled in the FLS clinic from April 2022 to March 2024. The primary objectives of the study were to determine the proportion of patients seen in an FLS clinic for osteoporotic fractures who did not meet usual criteria for bone density screening, and amongst those patients, the number whose bone density measurements would have resulted in a diagnosis of osteoporosis. The secondary objectives of the study were the frequency of different BMD indications in this population and the impact of T-score Range and Age Threshold on Fracture Detection.
Among the 1,248 patients analyzed, 772 (61.9%) were under 65 years. Of these, only 34% had indications for BMD testing according to the International Society for Clinical Densitometry (ISCD) guidelines. Fragility fractures after age 40, smoking and diseases associated with bone loss were the most frequent underlying conditions, justifying the BMD testing. (Respectively 143 (18.4%), 178 (22.4%), 139 (18%)) CONCLUSIONS: A significant proportion of patients under 65 years with fragility fractures do not meet current BMD testing criteria, potentially leading to unrecognized osteoporosis and subsequent fractures. This underscores the urgent need to revise osteoporosis screening guidelines to better identify at-risk individuals, thereby reducing the burden of fragility fractures.
尽管有有效的干预措施，但仍有相当数量的骨质疏松症患者未得到充分诊断和治疗，尤其是65岁以下的患者。本研究旨在评估转诊至骨折联络服务（FLS）诊所的65岁以下患者骨质疏松性骨折的发生率，并评估当前骨密度（BMD）检测指南的适用性。
我们对2022年4月至2024年3月在FLS诊所登记的患者的医疗档案进行了回顾性研究。该研究的主要目的是确定在FLS诊所因骨质疏松性骨折就诊但不符合骨密度筛查通常标准的患者比例，以及在这些患者中，骨密度测量结果可诊断为骨质疏松症的患者数量。该研究的次要目的是该人群中不同BMD检测指征的频率以及T评分范围和年龄阈值对骨折检测的影响。
在分析的1248例患者中，772例（61.9%）年龄在65岁以下。其中，根据国际临床骨密度测量学会（ISCD）指南，只有34%的患者有BMD检测指征。40岁后的脆性骨折、吸烟和与骨质流失相关的疾病是最常见的潜在情况，证明了进行BMD检测的合理性。（分别为143例（18.4%）、178例（22.4%）、139例（18%））结论：相当比例的65岁以下脆性骨折患者不符合当前BMD检测标准，这可能导致未被识别的骨质疏松症及随后的骨折。这凸显了迫切需要修订骨质疏松症筛查指南，以更好地识别高危个体，从而减轻脆性骨折的负担。
