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

• Published in: Calcified tissue international Vol. 93; no. 1; pp. 62 - 68
• Main Authors: Jiménez-Núñez, Francisco Gabriel, Manrique-Arija, Sara, Ureña-Garnica, Inmaculada, Romero-Barco, Carmen María, Panero-Lamothe, Blanca, Descalzo, Miguel Ángel, Carmona, Loreto, Rodríguez-Pérez, Manuel, Fernández-Nebro, Antonio
• Format: Journal Article
• Language: English
• Published: New York Springer New York 01.07.2013; Springer Nature B.V
• Subjects: Absorptiometry, Photon; Algorithms; Biochemistry; Biomedical and Life Sciences; Bone Density; Cell Biology; Cross-Sectional Studies; Densitometry; Endocrinology; Female; Humans; Life Sciences; Medical diagnosis; Medical imaging; Menopause; Middle Aged; Original Research; Orthopedics; Osteoporosis; Osteoporosis, Postmenopausal - diagnostic imaging; Osteoporosis, Postmenopausal - epidemiology; Risk Assessment; Womens health; Osteoporosis; Bone density; Diagnosis; DEXA
• ISSN: 0171-967X; 1432-0827
• DOI: 10.1007/s00223-013-9728-4

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.