Screening program including the Loco-check and fracture risk assessment tool (FRAX®) questionnaires for assessing locomotive syndrome in a municipality in Japan: A pilot study

Although the concept of locomotive syndrome and its relevant test methods have been established, approaches for incorporating them into regular health checkups have not been established. We aimed to assess the utility and problems of including Loco-check and the fracture risk assessment tool (FRAX®) as primary screening for locomotive syndrome during health checkups under the Act on Assurance of Medical Care for Elderly People (specified health checkup) in the municipality. Loco-check and FRAX® questionnaires were mailed to subjects eligible for the 2015 specified health checkup in Asahi-machi, Japan. Subjects with more than one affirmative response in the Loco-check questionnaire (Loco-check positive) or whose FRAX® major osteoporotic fracture risk was ≥10% (FRAX® positive) were identified as high risk and were evaluated in secondary checkups that included an locomotive syndrome risk test and sarcopenia and bone mineral density screenings. The degree of locomotive syndrome was assessed according to clinical diagnostic criteria of the Japanese Orthopaedic Association. Questionnaires were collected from 2209 subjects and included 1193 Loco-check-positive and 1108 FRAX®-positive subjects. There were 367 FRAX®-positive subjects who were Loco-check-negative and 452 Loco-check-positive subjects who were FRAX®-negative. Three hundred fifty-one subjects completed secondary checkups (42 in the no locomotive syndrome group, 171 in the locomo stage 1 group, and 138 in the locomo stage 2 group). Fourteen subjects had sarcopenia. The locomotive syndrome prevalence is high among subjects eligible for specified health checkups; these subjects were appropriate for locomotive syndrome screening. Using Loco-check and FRAX® in primary screening, many subjects can be evaluated for locomotive syndrome in a timely and cost-effective manner, a more diversified risk of fall/fracture can be obtained, and the sensitivity of screening may be increased. These checkup protocols will assist in promoting locomotive syndrome checkups in municipalities throughout Japan.