Osteoporosis International

, Volume 16, Issue 11, pp 1353–1362

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. Gasser
    • Osteoporosis PoliclinicUniversity Hospital of Berne
  • Christian Mueller
    • Osteoporosis PoliclinicUniversity Hospital of Berne
  • Marcel Zwahlen
    • Department of Social and Preventive MedicineUniversity of Berne
  • Manfred Kaufmann
    • Osteoporosis PoliclinicUniversity Hospital of Berne
  • Gaby Fuchs
    • Osteoporosis PoliclinicUniversity Hospital of Berne
  • Romain Perrelet
    • Osteoporosis PoliclinicUniversity Hospital of Berne
  • Gilbert Abetel
    • Swiss College of Family PractitionersClinical Research Group of the Swiss Foundation for General Medicine
  • Ulrich Bürgi
    • Department of Internal MedicineUniversity Hospital of Berne
    • Osteoporosis PoliclinicUniversity Hospital of Berne
Original Article

DOI: 10.1007/s00198-005-1846-z

Cite this article as:
Gasser, K.M., Mueller, C., Zwahlen, M. et al. Osteoporos Int (2005) 16: 1353. doi:10.1007/s00198-005-1846-z


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.


Case findingDXAGeneral practicePostmenopausal osteoporosisRadiographic absorptiometryRisk factors

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2005