Handgrip and phalangeal quantitative ultrasound are predictive of fracture risk in postmenopausal women screened for osteoporosis.

Osteoporosis and fractures increase with aging and lifespan is increasing worldwide. To promote early diagnosis of osteoporosis and reduce the related social burden, we screened all the postmenopausal women referring to our Centre during the last World Osteoporosis Day. We announced the initiative by a single communicate via local newspaper and television, and by a locandina affixed to the entrance of the Outpatients Clinics the day before. The invitation was targeted to postmenopausal women who had never been diagnosed nor treated for osteoporosis and who intended to know the health status of their bones and their fracture risk. Screening was based on a personal interview focused on clinical risk factors (CRFs), and the risk of major osteoporotic and hip fractures over ten years was estimated using the online version of the FRAX (Fracture Risk Assessment Tool) algorithm. Phalangeal quantitative ultrasound (QUS) and handgrip, which are indicator of bone and muscle strength respectively, were also evaluated and correlated to fracture risk. Eighty-six subjects (mean age 61.2±8.7) were screened. The median risk of major osteoporotic fracture (%) in the whole population was 6.3 (3.6-10) and the risk of hip fractures was 1.1 (0.4-3). The median risk of fracture increased with the number of CRFs (p<0.001). Women over 65 years were found to be at higher risk in comparison with subjects under 55 years: the median risk of major osteoporotic fractures was 12 (8-19) and 3.1 (2.5-3.9), while the risk of hip fracture was 3.9 (1.8-10.5) and 0.4 (0.3-0.5) respectively. QUS values and handgrip were both significantly inversely related to fracture risk evaluated by FRAX (p<0.05). As clinically appropriate, further investigations (e.g. DXA, RX, lab tests) were advised to women at higher fracture risk, in accordance to current Italian guideline. Application of FRAX combined with QUS and handgrip could be clinically useful to select women at risk for fracture suggesting further investigations, finally reducing social costs.