Calcified Tissue International

, Volume 93, Issue 1, pp 62–68 | Cite as

Reducing the Need for Central Dual-Energy X-Ray Absorptiometry in Postmenopausal Women: Efficacy of a Clinical Algorithm Including Peripheral Densitometry

  • Francisco Gabriel Jiménez-Núñez
  • Sara Manrique-Arija
  • Inmaculada Ureña-Garnica
  • Carmen María Romero-Barco
  • Blanca Panero-Lamothe
  • Miguel Ángel Descalzo
  • Loreto Carmona
  • Manuel Rodríguez-Pérez
  • Antonio Fernández-Nebro
Original Research

Abstract

We evaluated the efficacy of a triage approach based on a combination of osteoporosis risk-assessment tools plus peripheral densitometry to identify low bone density accurately enough to be useful for clinical decision making in postmenopausal women. We conducted a cross-sectional diagnostic study in postmenopausal Caucasian women from primary and tertiary care. All women underwent dual-energy X-ray absorptiometric (DXA) measurement at the hip and lumbar spine and were categorized as osteoporotic or not. Additionally, patients had a nondominant heel densitometry performed with a PIXI densitometer. Four osteoporosis risk scores were tested: SCORE, ORAI, OST, and OSIRIS. All measurements were cross-blinded. We estimated the area under the curve (AUC) to predict the DXA results of 16 combinations of PIXI plus risk scores. A formula including the best combination was derived from a regression model and its predictability estimated. We included 505 women, in whom the prevalence of osteoporosis was 20 %, similar in both settings. The best algorithm was a combination of PIXI + OST + SCORE with an AUC of 0.826 (95 % CI 0.782–0.869). The proposed formula is Risk = (–12) × [PIXI + (−5)] × [OST + (−2)] × SCORE and showed little bias in the estimation (0.0016). If the formula had been implemented and the intermediate risk cutoff set at −5 to 20, the system would have saved €4,606.34 in the study year. The formula proposed, derived from previously validated risk scores plus a peripheral bone density measurement, can be used reliably in primary care to avoid unnecessary central DXA measurements in postmenopausal women.

Keywords

Bone density DEXA Osteoporosis Diagnosis 

References

  1. 1.
    SEIOMM (2003) Osteoporosis postmenopáusica. Guía de práctica clínica. Rev Clin Esp 203:496–506CrossRefGoogle Scholar
  2. 2.
    Looker AC, Orwoll ES, Johnston CC Jr, Lindsay RL, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP (1997) Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res 12:1761–1768PubMedCrossRefGoogle Scholar
  3. 3.
    Cooper C (1999) Epidemiology of osteoporosis. Osteoporos Int 9(Suppl 2):S2–S8PubMedCrossRefGoogle Scholar
  4. 4.
    Dell R, Greene D (2010) Is osteoporosis disease management cost effective? Curr Osteoporos Rep 8:49–55PubMedCrossRefGoogle Scholar
  5. 5.
    Kanis JA (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int 4:368–381PubMedCrossRefGoogle Scholar
  6. 6.
    Kanis JA, Melton LJ 3rd, Christiansen C, Johnston CC, Khaltaev N (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141PubMedCrossRefGoogle Scholar
  7. 7.
    Cadarette SM, Jaglal SB, Murray TM (1999) Validation of the Simple Calculated Osteoporosis Risk Estimation (SCORE) for patient selection for bone densitometry. Osteoporos Int 10:85–90PubMedCrossRefGoogle Scholar
  8. 8.
    Cadarette SM, Jaglal SB, Kreiger N, McIsaac WJ, Darlington GA, Tu JV (2000) Development and validation of the osteoporosis risk assessment instrument to facilitate selection of women for bone densitometry. Can Med Assoc J 162:1289–1294Google Scholar
  9. 9.
    Richy F, Gourlay M, Ross PD, Sen SS, Radican L, De Ceulaer F, Ben Sedrine W, Ethgen O, Bruyere O, Reginster JY (2004) Validation and comparative evaluation of the Osteoporosis Self-Assessment Tool (OST) in a Caucasian population from Belgium. QJM 97:39–46PubMedCrossRefGoogle Scholar
  10. 10.
    Sedrine WB, Chevallier T, Zegels B, Kvasz A, Micheletti MC, Gelas B, Reginster JY (2002) Development and assessment of the Osteoporosis Index of Risk (OSIRIS) to facilitate selection of women for bone densitometry. Gynecol Endocrinol 16:245–250PubMedGoogle Scholar
  11. 11.
    Williams ED, Daymond TJ (2003) Evaluation of calcaneus bone densitometry against hip and spine for diagnosis of osteoporosis. Br J Radiol 76:123–128PubMedCrossRefGoogle Scholar
  12. 12.
    Lydick E, Cook K, Turpin J, Melton M, Stine R, Byrnes C (1998) Development and validation of a simple questionnaire to facilitate identification of women likely to have low bone density. Am J Manag Care 4:37–48PubMedGoogle Scholar
  13. 13.
    Geusens P, Hochberg MC, van der Voort DJ, Pols H, van der Klift M, Siris E, Melton ME, Turpin J, Byrnes C, Ross P (2002) Performance of risk indices for identifying low bone density in postmenopausal women. Mayo Clin Proc 77:629–637PubMedCrossRefGoogle Scholar
  14. 14.
    Efron B, Tibshirani R (1998) An introduction to the bootstrap. Chapman & Hall, New YorkGoogle Scholar
  15. 15.
    Fuentes M, Ferrer J, Grifols M, Badia X, Guilerad M, OPTIMA Grupo mujer (2007) Diagnostic management of patients with osteoporosis treated in primary care consultations in Spain. Semergen 33:45–49 in SpanishCrossRefGoogle Scholar
  16. 16.
    Azagra Ledesma R, Prieto-Alhambra D, Encabo Duro G, Casado Burgos E, Aguye Batista A, Diez-Perez A (2011) Usefulness of FRAX tool for the management of osteoporosis in the Spanish female population. Med Clin (Barc) 136:613–619 in SpanishCrossRefGoogle Scholar
  17. 17.
    Martinez-Aguila D, Gomez-Vaquero C, Rozadilla A, Romera M, Narvaez J, Nolla JM (2007) Decision rules for selecting women for bone mineral density testing: application in postmenopausal women referred to a bone densitometry unit. J Rheumatol 34:1307–1312PubMedGoogle Scholar
  18. 18.
    Lofman O, Larsson L, Toss G (2000) Bone mineral density in diagnosis of osteoporosis: reference population, definition of peak bone mass, and measured site determine prevalence. J Clin Densitom 3:177–186PubMedCrossRefGoogle Scholar
  19. 19.
    Roux C (2001) Can practitioners use the WHO definition for osteoporosis? Joint Bone Spine 68:10–11PubMedCrossRefGoogle Scholar
  20. 20.
    Knapp KM, Blake GM, Spector TD, Fogelman I (2004) Can the WHO definition of osteoporosis be applied to multi-site axial transmission quantitative ultrasound? Osteoporos Int 15:367–374PubMedCrossRefGoogle Scholar
  21. 21.
    Sosa Henriquez M (2005) Osteoporosis: the problem of its definition. Med Clin (Barc) 124:259–260 in SpanishCrossRefGoogle Scholar
  22. 22.
    Diaz Curiel M, Garcia JJ, Carrasco JL, Honorato J, Perez Cano R, Rapado A, Alvarez Sanz C (2001) Prevalence of osteoporosis assessed by densitometry in the Spanish female population. Med Clin (Barc) 116:86–88 in SpanishCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Francisco Gabriel Jiménez-Núñez
    • 1
  • Sara Manrique-Arija
    • 1
  • Inmaculada Ureña-Garnica
    • 1
  • Carmen María Romero-Barco
    • 1
  • Blanca Panero-Lamothe
    • 1
  • Miguel Ángel Descalzo
    • 2
  • Loreto Carmona
    • 3
  • Manuel Rodríguez-Pérez
    • 1
  • Antonio Fernández-Nebro
    • 1
  1. 1.Rheumatology ServiceHospital Regional Universitario Carlos HayaMálagaSpain
  2. 2.Research UnitFundación Española de ReumatologíaMadridSpain
  3. 3.Health Sciences SchoolUniversidad Camilo José CelaMadridSpain

Personalised recommendations