Osteoporosis is Underdiagnosed in Skilled Nursing Facilities: A Large-Scale Heel BMD Screening Study

F. Michael Gloth, William Simonson

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Objective: To investigate the common assertion that osteoporosis is underdiagnosed in the skilled nursing facility setting. Methods: Skilled nursing facilities participated in a nationwide heel-screening study conducted by their local consultant pharmacists. The nursing facility residents were categorized into 4 age groups: 59 years and younger; 60 to 69 years; 70 to 79 years; and 80 years and older. Residents were screened on a voluntary basis. Heel scanning was performed using a peripheral dual-energy x-ray absorptiometry (pDXA) machine, and the data were collected by an independent contractor (On-Site Wellness). Residents were grouped by low, moderate, or high risk for osteoporosis based on their bone mineral density (BMD) T-scores. Bedridden patients, patients with a short life expectancy, and those currently receiving osteoporosis therapy were excluded from the study. Results: A total of 34,486 residents of skilled nursing facilities in 26 states were screened, 7728 (22.4%) of whom were grouped as low risk, 12,095 (35.1%) as moderate risk, and 14,663 (42.5%) as high risk for osteoporosis and related fracture. Findings by state were comparable to those for the total study population. Conclusion: This large-scale heel-screening study suggests a considerable prevalence of undiagnosed osteoporosis (as measured by peripheral DXA scans) in skilled nursing facilities, underscoring the need for more vigilant awareness of fracture risk in these patients.

Original languageEnglish (US)
Pages (from-to)190-193
Number of pages4
JournalJournal of the American Medical Directors Association
Issue number3
StatePublished - Mar 2008


  • Osteoporosis
  • peripheral DXA scan
  • skilled nursing facilities

ASJC Scopus subject areas

  • Nursing(all)
  • Health Policy
  • Geriatrics and Gerontology


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