UNASSIGNED: Osteoporosis is the most common bone disease in the world. Approximately 50% of women and 20% of men over 50 will suffer an osteoporosis-related fracture. Future health care providers must be equipped to prevent, recognize, and treat osteoporosis-related fractures.
UNASSIGNED: To supplement instruction on osteoporosis, we designed a case-based session. Groups of 10-12 second-year medical students worked with a single facilitator in a roundtable discussion. The 120-minute session integrated foundational sciences (pathology, physiology, pharmacology) and clinical disciplines (clinical skills, radiology, geriatrics, evidence-based medicine). Knowledge gains were assessed by performance on nine session-relevant multiple-choice questions (MCQs) on the final exam. Student satisfaction was assessed by an anonymous postsession survey.
UNASSIGNED: There were 121 students that participated, and their average performance on nine session-relevant final exam MCQs was 84%. After removal of a single outlier MCQ (15% correct), average performance on the remaining eight MCQs was 93%. A total of 107 students (88%) responded to the postsession survey. On a 5-point Likert scale, 101 of 107 students (94%) agreed or strongly agreed with the statement \"The basic science-clinical combination lecture on osteoporosis followed by the small-group case discussion on osteoporosis prepared me adequately to understand the topic\" (M = 4.56, SD = 0.63).
UNASSIGNED: We developed a case-based learning activity for preclinical medical students to enhance the clinical scaffolding of basic science and medical knowledge around osteoporosis. Students performed well on session-relevant exam questions, demonstrating competency in the educational objectives. Student satisfaction was high, with most students feeling well prepared.

This study evaluated the predictive power of adjusted FRAX and standard FRAX models based on the actual prevalence of osteoporosis in type 2 diabetic (T2DM) postmenopausal women, and to explore the optimal strategy to better predicted fracture risk in postmenopausal women with diabetes in China.
We recruited 434 patients from community-medical centers, 217 with T2DM and 217 without T2DM (non-T2DM). All participants completed self-reported questionnaires detailing their characteristics and risk factors. Bone mineral density (BMD) and spinal radiographs were evaluated. The China FRAX model calculated all scores. The area under the receiver operator characteristic curve (ROC-AUC) evaluated the sensitivity, specificity, and accuracy for predicting 10-year risk for major (MOF) and hip (OHF) osteoporotic fractures in T2DM patients.
T2DM patients had higher BMD but lower average FRAX values than non-T2DM patients. The unadjusted FRAX ROC-AUC was 0.774, significantly smaller than that for 0.5-unit femoral neck T-score-adjusted FRAX (0.800; p = 0.004). Rheumatoid arthritis (RA; AUC = 0.810, p = 0.033) and T-score (AUC = 0.816, p = 0.002) adjustments significantly improved fracture prediction in T2DM patients.
Femoral neck T-score adjustment might be the preferred method for predicting MOF and OHF in Chinese diabetic postmenopausal women, while RA adjustment only effectively predicted HF risk.

Fracture risk calculators (FRC) with DXA can guide osteoporosis (OP) management in the absence of dual X-ray absorptiometry (DXA). There is little information of the role of FRC without DXA.
Determine the accuracy of age-stratified Garvan FRC thresholds without DXA to manage OP.
Cross-sectional study of 531 participants, ≥70 years old who underwent DXA and had Garvan FRC scores with and without DXA calculated. Age-stratified Garvan scores without DXA, generated low (no action), moderate (order DXA) or high (treat without DXA) risk thresholds of OP. Accuracy of our thresholds were assessed against DXA confirmed OP.
Age-specific GARVAN thresholds resulted in the correct decision in 85-88% of cases; \"over-treated\" OP in 7-8%; and, missed OP in 5-8%. 256 (48%) DXAs were unnecessary. Compared to recommended guidelines, Garvan HF and MOF thresholds improved accuracy of clinical decisions by 31% and 12%, respectively.
Age-specific FRC score thresholds successfully identified who required treatment or DXA, with potential to reduce unnecessary DXA.