Fortnightly Review: Bone densitometry in clinical practice

Abstract

Summary points Osteoporosis is a major health problem in the elderly population. It causes more than 150000 fractures each year in the United Kingdom with an estimated cost of pounds sterling742 million Bone mass is a major determinant of risk of fracture and can be assessed by non-invasive techniques such as dual energy x ray absorptiometry Densitometric criteria based on standard deviation scores expressed in relation to reference values in premenopausal women (T scores) provide diagnostic categories from which thresholds for prevention and treatment can be defined on the basis of risk of fracture Population based screening for low bone mass in perimenopausal women cannot at present be justified. In clinical practice, however, bone densitometry has an important role in the diagnosis of osteoporosis in high risk groups and in the monitoring of treatment in some patients For these indications, it is estimated that about 175 bone scans per 100000 population would be needed annually, requiring an annual expenditure for the average health district of pounds sterling25200 At present, bone densitometry resources in the United Kingdom are inadequate to meet these needs. There is an urgent need to improve existing facilities so that effective strategies for the prevention and treatment of osteoporosis in clinical practice can be implemented

Utility of medical and drug history in fracture risk prediction among men and women

“…Several guidelines for the management of osteoporosis 4,12,20 suggest that bone densitometry is best used in patients with radiological evidence of osteopenia or vertebral deformity, in those with a history of fragility fractures, and among those with certain clinical risk factors. Unfortunately, many of these clinical risk factors are not routinely recorded in primary care.…”

Treatment of established osteoporosis: a systematic review and cost-utility analysis

“…This approach has been adopted in many practice guidelines. 42,[45][46][47] The identification of patients with fragility fractures and subsequent measurement of BMD forms an intuitive strategy, provided that intervention can decrease the burden of fracture.…”

Does a Fracture at One Site Predict Later Fractures at Other Sites? A British Cohort Study

“…It is characterized by low bone density and disruption of bone architecture, which leads to an increased risk of fracture [1]. Bone density can be assessed by noninvasive techniques such as dual-energy X-ray absorptiometry [2]. Several guidelines recommend restricting the use of bone densitometry in the diagnosis of osteoporosis primarily to patients with clinical risk factors for a fracture, such as a previous fragility fracture of the hip, spine or wrist [3,4].…”