Original Article

Osteoporosis International

, Volume 16, Issue 11, pp 1353-1362

First online:

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

  • Katharina M. GasserAffiliated withOsteoporosis Policlinic, University Hospital of Berne
  • , Christian MuellerAffiliated withOsteoporosis Policlinic, University Hospital of Berne
  • , Marcel ZwahlenAffiliated withDepartment of Social and Preventive Medicine, University of Berne
  • , Manfred KaufmannAffiliated withOsteoporosis Policlinic, University Hospital of Berne
  • , Gaby FuchsAffiliated withOsteoporosis Policlinic, University Hospital of Berne
  • , Romain PerreletAffiliated withOsteoporosis Policlinic, University Hospital of Berne
  • , Gilbert AbetelAffiliated withSwiss College of Family Practitioners, Clinical Research Group of the Swiss Foundation for General Medicine
  • , Ulrich BürgiAffiliated withDepartment of Internal Medicine, University Hospital of Berne
  • , Kurt LippunerAffiliated withOsteoporosis Policlinic, University Hospital of Berne Email author 

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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.

Keywords

Case finding DXA General practice Postmenopausal osteoporosis Radiographic absorptiometry Risk factors