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Point-of-Care Phalangeal Bone Mineral Density Measurement Can Reduce the Need of Dual-Energy X-Ray Absorptiometry Scanning in Danish Women at Risk of Fracture

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Abstract

Identifying persons with a high risk of osteoporotic fractures remains a challenge. DXA uptake in women with elevated risk of osteoporosis seems to be depending on distance to scanning facilities. This study aimed to investigate the ability of a small portable scanner in identifying women with reduced bone mineral density (BMD), and to define triage thresholds for pre-selection. Total hip and lumbar spine BMD was measured by dual-energy X-ray absorptiometry and phalangeal BMD by radiographic absorptiometry in 121 Danish women with intermediate or high 10-year fracture probability (aged 61–81 years). Correlation between the two methods was estimated using correlation coefficient (r) and Bland–Altman plots. A moderate correlation between phalangeal BMD versus total hip (r = 0.47) and lumbar spine (r = 0.51), and an AUC on 0.80 was found. The mean difference between phalangeal T score and total hip T score/lumbar spine T score was low, and ranged from −0.26 SD to −0.31 SD depending on site and reference database used for calculation of T scores, but, large variation was seen at an individual level. When applying a triage approach approx. one-third of all DXA scan could be avoided and only 6 % of women in the low-risk group would be false negatives.

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Acknowledgments

Many thanks to the participants in the Rose study and technical staff in the two involved hospitals: Odense University Hospital, Odense and Hospital of Southwest Denmark, Esbjerg, Denmark. Funding was provided from INTERREG 4A (JNR 08/4177) and the Region of Southern Denmark.

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Authors and Affiliations

  1. National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2, 1399, Copenhagen K, Denmark

    Teresa Holmberg

  2. KORA, the Danish Institute for Local and Regional Government Research, Copenhagen, Denmark

    Mickael Bech

  3. Department of Endocrinology, Hospital of Southwest Denmark, Esbjerg, Denmark

    Jeppe Gram

  4. Department of Endocrinology, Odense University Hospital, Odense, Denmark

    Anne Pernille Hermann & Kim Brixen

  5. Odense Patient Data Explorative Network (OPEN), Institute of Clinical Research, University of Southern Denmark, Odense M, Denmark

    Katrine Hass Rubin

Authors
  1. Teresa Holmberg
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  2. Mickael Bech
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  4. Anne Pernille Hermann
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  5. Katrine Hass Rubin
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  6. Kim Brixen
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Corresponding author

Correspondence to Teresa Holmberg.

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Conflict of Interest

Teresa Holmberg, Mickael Bech, Jeppe Gram and Katrine Hass Rubin have no conflict of interest. Anne Pernille Hermann: Eli Lilly, MSD, and Amgen (Advisory Board) and Amgen, Lilly, Genzyme (Speakers Bureau). Kim Brixen: Consulting (study design) MSD, Investigator MSD, Amgen, Novartis, NPS, Speakers bureau Amgen, GlaxoSmithKline, Grants MSD.

Human and Animal Rights and Informed Consent

The ROSE study is registered in ClinicalTrials.gov (NCT01388244) and performed according to the declaration of Helsinki II. The ROSE study is, furthermore, approved by the Regional Scientific Ethical Committee for Southern Denmark (jr.nr S-20090127). The present sub-study was approved by amendment number 2 “Validation of Phalangeal densitometer (Alara MetriScan)”. Moreover, the study was approved by the Danish Data Protection Agency. Participants received oral and written information before signing informed consent.

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Holmberg, T., Bech, M., Gram, J. et al. Point-of-Care Phalangeal Bone Mineral Density Measurement Can Reduce the Need of Dual-Energy X-Ray Absorptiometry Scanning in Danish Women at Risk of Fracture. Calcif Tissue Int 98, 244–252 (2016). https://doi.org/10.1007/s00223-015-0084-4

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  • DOI: https://doi.org/10.1007/s00223-015-0084-4

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