1st par: Osteoporosis wisely known as the silent disease is the most common metabolic disease emerging insidiously and microscopically in the texture of the bone tissue, resulting in skeletal fragility that leads to fractures causing mortality and disability. (Larijani, Resch et al. 2007, Brian K Alldredge; Koda-Kimble 2009) Due to the high morbidity and mortality affecting both the patient and the society, it’s often regarded as a global public health problem. It is considered a health priority in Iran and is one of the major contributors of the global burden of non-communicable diseases.
2nd par: As the number of elderly population grows in industrialized countries, the ...view middle of the document...
4% of the burden of hip fracture in the Middle East is contributed to Iran. (Ahmadi-Abhari, Moayyeri et al. 2007)The prevalence of osteoporosis and its complications are influenced by many factors such as geographical properties, genetics, ethnicities, latitude, population demographics as well as other environmental factors.
3rd par: Timely diagnosis, prevention of osteoporotic fractures and appropriate treatment depends on screening osteoporosis. Currently the best recommended method for screening osteoporosis is bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA). However, it should be mentioned that DXA scan is not recommended as a screening tool for the whole population. Among the 126 DXA machines, 52 devices are located in Tehran, the capital of Iran, leaving 74 devices for the other 30 provinces. DXA is not available in five provinces of Iran. ( http://www.iofbonehealth.org/sites/default/files/PDFs/Audit%20Middle%20East_Africa/ME_Audit-Iran.pdf) This is mainly because the distribution of population is unbalanced in Iran, influenced by many factors such as environmental factors. There are areas with a population density of 5000 to 57000 per square kilometers, which compromise a small area in the country, leaving some regions, particularly deserts uninhibited or with sparse population. (Masoum, Hamid et al. 2014)Ultimately, it is been concluded that densitometry is overused in some areas and underused in some others, influenced by availability and socioeconomic factors.(Rubin, Abrahamsen et al. 2011) So attempts must be made to clarify the needs and indications for this diagnostic test. Criteria for identifying high risk patients should be identified so that unnecessary test can be avoided, meanwhile no patient in need of DXA shall be missed, and thus an accurate and simple assessment tool should be provided for pre-screening in primary care centers.
4th par: With DXA being relatively expensive and unavailable in some areas, developing pre-screening tests, often referred to as the triage tests, is of benefit. (Bossuyt PM 2006) The first study of this category, is the Slemenda’s study in 1990. (Slemenda, Hui et al. 1990)However it was not validated and the model was later considered a poor model. Many other studies were then conducted to evaluate such models. (Nelson, Helfand et al. 2002)The most commonly used models are the SCORE (Simple Calculated Osteoporosis Risk Estimation) and the ORAI (Osteoporosis Risk Assessment Instrument) model, developed in 1998 by Lydick et al and Cadarette et al in 2000, respectively. The SCORE model had a sensitivity of 89% and a specificity of 50% and ORAI had a sensitivity of 95% and a specificity of 41% in these studies. (Lydick, Cook et al. 1998, Cadarette SM 2000) Other models include Osteoporosis Self-Assessment Tool (OST), SOFSURF, Osteoporosis Index of Risk (OSIRIS) and Age, body size, no estrogen (ABONE). (Rud, Hilden et al. 2009)
5th par: Considering the multifactorial nature...