Osteoporosis International

, Volume 17, Issue 1, pp 68–76 | Cite as

Economic comparison of diagnostic approaches for evaluating osteoporosis in older women

  • Dale F. Kraemer
  • Heidi D. Nelson
  • Douglas C. Bauer
  • Mark Helfand
Original Article


Of the technologies available, dual-energy X-ray absorptiometry of the hip or femoral neck (DXA-FN) is the best predictor of hip fractures. Diagnostic approaches utilizing measures of peripheral sites with office-based technology, such as calcaneal quantitative ultrasound (QUS), may reduce costs although clinical and economic outcomes have not been evaluated. The objective was to compare three approaches for diagnosing osteoporosis in older women. The design was a decision-analytic model using diagnostic measures and clinical and economic outcomes from the Study of Osteoporotic Fractures, a prospective cohort of older white women that measured BMD and QUS and assessed fracture outcomes. The setting and patients were a hypothetical cohort of older white women presenting for diagnosis of osteoporosis. For the diagnostic and treatment alternatives, three diagnostic approaches—DXA-FN alone, QUS alone and a sequential approach (first QUS, then DXA-FN for those with low values for QUS)—were compared to no diagnosis. The outcome measures were the number of women identified for treatment, number of hip fractures prevented following diagnosis and subsequent treatment, number of women needed to treat to prevent one hip fracture and total direct medical costs. The sequential approach identified fewer women to treat, prevented more hip fractures and incurred lower total costs than using DXA alone. Diagnosis with QUS alone identified more women to treat and incurred higher total costs than DXA alone under most conditions. Compared to other approaches for diagnosing osteoporosis, sequential use of QUS followed by DXA resulted in fewer women treated and lower total costs.


Bone mineral density Costs Densitometry Osteoporosis Postmenopausal women 


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2005

Authors and Affiliations

  • Dale F. Kraemer
    • 1
    • 3
  • Heidi D. Nelson
    • 1
    • 2
  • Douglas C. Bauer
    • 4
  • Mark Helfand
    • 1
    • 2
    • 5
  1. 1.Department of Medical Informatics and Clinical Epidemiology and Evidence-based Practice CenterOregon Health and Science UniversityPortlandUSA
  2. 2.Department of MedicineOregon Health and Science UniversityPortlandUSA
  3. 3.Department of Pharmacy PracticeOregon State UniversityPortlandUSA
  4. 4.Division of General Internal Medicine and Department of Epidemiology and BiostatisticsUniversity of California at San FranciscoSan FranciscoUSA
  5. 5.Medical ServiceVeterans Affairs Medical CenterPortlandUSA

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