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Patient assessment using standardized bone mineral density values and a national reference database: implementing uniform thresholds for the reimbursement of osteoporosis treatments in Belgium

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Abstract

Dual-energy X-ray absorptiometry (DXA) devices from the three main manufacturers provide different bone mineral density (BMD) values, due in part to technical differences in the algorithms for bone mineral content (BMC) and area measurements and in part to the use of different manufacturer-derived reference databases. As a result, significant differences exist between Hologic, Lunar and Norland systems in the reported young normal standard deviation scores or T-scores. In a number of European countries, including Belgium, a T-score below −2.5 is one of the key criteria for reimbursement of osteoporosis treatments. This paper addresses the first attempt to implement a nationwide, uniform expression of BMD in patients, in order to harmonize drug reimbursement. To this end, measures were taken to implement a uniform expression of BMD in Belgian patients, by converting each manufacturer's absolute BMD to standardized BMD (sBMD) values and by establishing a single national reference range.

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Acknowledgements

The authors are grateful for logistic support from Hologic Inc., Lunar Corporation and Norland Corporation and to Drs. Bersou, Blockeel, Boutsen, Casaer, Coolen, Crombez, De Boeck, de Buisseret, Delval, Dorny, Dumont, Dwelshauwer, Gaudissart, Geusens, Goethals, Gomez, Grégoire, Hendrickx, Jacques, Lamberigts, Lenaeerts, Louis, Mertens, Milet, Pornel, Raeman, Remans, Temmerman, Troch, Vancleynenbreugel, Van Laere, Van Meerbeek, Van Wanghe and Verbeek for recruiting and assessing subjects. S.B. is senior clinical investigator of the Fund for Scientific Research—Flanders, Belgium (FWO—Vlaanderen).

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Author notes

  1. J.-P. Devogelaer

    Present address: Service de Rhumatologie, UCL 5390, Saint-Luc University Hospital, Avenue Hippocrate 10, 1200, Brussels, Belgium

Authors and Affiliations

  1. Leuven University Center for Metabolic Bone Diseases and Division of Geriatric Medicine, Katholieke Universiteit Leuven,

    S. Boonen

  2. Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital,

    J.-M. Kaufman

  3. Centre Universitaire d'Investigation du Métabolisme Osseux et du Cartilage Articulaire, State University of Liège,

    J.-Y. Reginster

  4. Arthritis Unit, Université catholique de Louvain, Belgium

    J.-P. Devogelaer

Authors
  1. S. Boonen
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  2. J.-M. Kaufman
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  3. J.-Y. Reginster
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  4. J.-P. Devogelaer
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Consortia

on behalf of the Belgian Bone Club (BBC)

Corresponding author

Correspondence to J.-P. Devogelaer.

Appendixes

Appendixes

Appendix A: The executive board of the Belgian Bone Club

The executive board of the Belgian Bone Club consists of the following investigators: Jean-Jacques Body, MD, PhD (Université Libre de Bruxelles), Steven Boonen, MD, PhD (Katholieke Universiteit Leuven), Marc E. De Broe, MD, PhD (University of Antwerpen), Jean-Pierre Devogelaer, MD (Université catholique de Louvain), Jean-Marc Kaufman, MD, PhD (Rijks Universiteit Gent), Jean-Yves Reginster, MD, PhD (Université d'Etat de Liège), Jan Remans (Genk) and Serge Rosenberg, MD, PhD (Université Libre de Bruxelles).

Appendix B: Various formulas used to standardize the BMD values

Lumbar spine sBMD (mg/cm 2 )

  • Genant et al. [4]

    Hologic::

    LS BMD=(1.0755×BMDH)×1000

    Lunar::

    LS BMD=(0.9522×BMDL)×1000

    Norland::

    LS BMD=(1.0761×BMDN)×1000

  • Hui et al. [5]

    Hologie::

    LS BMD=[1.0550 (BMDH−0.972)+1.0436]×1000

    Lunar::

    LS BMD=[0.9683 (BMDL−1.100)+1.0436]×1000

    Norland::

    LS BMD=[0.9743 (BMDN−0.969)+1.0436]×1000

Total hip sBMD (mg/cm 2 )

  • Hanson et al. [6]

    Hologic::

    TH sBMD=1.008×BMDH+6

    Lunar::

    TH sBMD=979×BMDL−31

    Norland::

    TH sBMD=1012×BMDN)+26

  • Lu et al. [7]

    Hologic::

    TH sBMD=[(0.006+1.008)×BMDH]×1000

    Lunar::

    TH sBMD=[(-0.031+0.979)×BMDL]×1000

    Norland::

    TH sBMD=[(0.026+1.012)×BMDN]×1000

Femoral neck sBMD (mg/cm 2 )

  • Lu et al. [7]

    Hologic::

    FN sBMD=[(0.019+1.087)×BMDH]×1000

    Lunar::

    FN sBMD=[(-0.023+0.939)×BMDL]×1000

    Norland::

    FN sBMD=[(0.006+0.985)×BMDN]×1000

  • Simmons et al. [8]

    Hologic::

    FN sBMD=[(1.031×BMDH)+0.058]×1000

    Lunar::

    FN sBMD=[(0.961×BMDL)−0.037]×1000

    Norland::

    FN sBMD=BMDN×1000

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Boonen, S., Kaufman, JM., Reginster, JY. et al. Patient assessment using standardized bone mineral density values and a national reference database: implementing uniform thresholds for the reimbursement of osteoporosis treatments in Belgium. Osteoporos Int 14, 110–115 (2003). https://doi.org/10.1007/s00198-002-1321-z

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  • DOI: https://doi.org/10.1007/s00198-002-1321-z

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