Osteoporosis case finding in the general practice: phalangeal radiographic absorptiometry with and without risk factors for osteoporosis to select postmenopausal women eligible for lumbar spine and hip densitometry

Abstract

Mass screening for osteoporosis using DXA measurements at the spine and hip is presently not recommended by health authorities. Instead, risk factor questionnaires and peripheral bone measurements may facilitate the selection of women eligible for axial bone densitometry. The aim of this study was to validate a case finding strategy for postmenopausal women who would benefit most from subsequent DXA measurement by using phalangeal radiographic absorptiometry (RA) alone or in combination with risk factors in a general practice setting. The sensitivity and specificity of this strategy in detecting osteoporosis (T-score £ 2.5 SD at the spine and/or the hip) were compared with those of the current reimbursement criteria for DXA measurements in Switzerland. Four hundred and twenty-three postmenopausal women with one or more risk factors for osteoporosis were recruited by 90 primary care physicians who also performed the phalangeal RA measurements. All women underwent subsequent DXA measurement of the spine and the hip at the Osteoporosis Policlinic of the University Hospital of Berne. They were allocated to one of two groups depending on whether they matched with the Swiss reimbursement conditions for DXA measurement or not. Logistic regression models were used to predict the likelihood of osteoporosis versus ''no osteoporosis'' and to derive ROC curves for the various strategies. Differences in the areas under the ROC curves (AUC) were tested for significance. In women lacking reimbursement criteria, RA achieved a significantly larger AUC (0.81; 95% CI 0.72-0.89) than the risk factors associated with patients' age, height and weight (0.71; 95% C.I. 0.62-0.80). Furthermore, in this study, RA provided a better sensitivity and specificity in identifying women with underlying osteoporosis than the currently accepted criteria for reimbursement of DXA measurement. In the Swiss environment, RA is a valid case finding tool for patients with risk factors for osteoporosis, especially for those who do not qualify for DXA reimbursement.

Simulation-based cost-utility analysis of population screening-based alendronate use in Switzerland

“…Finally, this study did not assess the cost-effectiveness of scenarios involving a pre-selection of sub-populations at high risk of osteoporosis. Earlier studies have shown that selective case-finding based on a combination of risk factors, with or without radiographic absorptiometry, provided a better sensitivity and specificity in identifying women with underlying osteoporosis than the currently accepted criteria for reimbursement of DXA measurements in Switzerland [59]. In addition, the pre-selection of women and men at highest risk of osteoporosis, and who should therefore undergo BMD measurement by DXA, based on the determination of their 10-year absolute fracture risk may considerably improve the cost-effectiveness of the population-based screen-and-treat approach [60][61][62][63][64].…”

Quantitative ultrasound and radiographic absorptiometry are associated with vertebral deformity in Japanese Women: the Hizen–Oshima study

“…It has been reported that peripheral low BMD identified women with osteoporosis defined by axial DXA [28,29]. Moreover, Miller et al have reported that low peripheral BMD, regardless of sites measured, was associated with twofold or more increased risk of subsequent fractures [14].…”

Screening and prevention in Swiss primary care: a systematic review

“…The following papers in our review indicated sponsorship or conflicts of interest, as noted • Bovier et al: 13 The 51 Support by the Health Authority of the Canton of Geneva • Gasser et al: 38 Provision of the digital processing system: Merck Sharp and Dohme-Chibret AG Switzerland • Gauthey et al: 14 Grant from the President of the State Department for Health and Social Affairs • Gugelmann et al: 15 Financial support of the study by SmithKline Beecham corporation • Hayoz et al: 27 Support by a grant from Bristol-Myers Squibb and Sanofi-Synthelabo • Jimmy and Martin: 53 Financial support by Helsana AG • Marki et al: 55,56 Financial support of the study by Health Promotion Switzerland (project 1191)…”

“…Twelve studies addressed the prevention of infectious diseases, especially influenza by providing vaccinations [11][12][13][14][15][16][17][18][19][20][21][22] or by performing a specific diagnostic test. 22 For clinical topics, most prevention activities addressed cardiovascular disease prevention, [23][24][25][26][27][28][29][30] cancer screening, [31][32][33][34] HIV, [35][36][37] prevention of osteoporosis, 38,39 addiction prevention, 40,41 and others [42][43][44][45][46][47] (Table 2). The most common observed intervention was counseling on lifestyle changes with twelve studies.…”

“…11,13,14,16,18,24,28,29,32,34,37,38,40,43,48,[50][51][52][53][54][55][56][57][58] The most frequently cited facilitators were " education/ knowledge" (8 out of 23), 11,14,16,22,24,32,50,54,55 " conviction/ motivation/ information" (5 out of 23) 28,34,43,48,50,51 and " feasibility/usefulness" (4 out of 23). 11,13,38,53 Counselling Information and GP's advice to use screening and preventive services are supporting factors. 11,14,16,22,24,32,55…”