title: Reducing the need for central dual-energy X-ray absorptiometry in postmenopausal women: efficacy of a clinical algorithm including peripheral densitometry.
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 <euro>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.
authors.affiliation: Rheumatology Service, Hospital Regional Universitario Carlos Haya, Plaza del Hospital Civil s/n, 29009, Málaga, Spain.
authors.forename: Francisco Gabriel
authors.initials: FG
authors.lastname: Jiménez-Núñez
authors.forename: Sara
authors.initials: S
authors.lastname: Manrique-Arija
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Ureña-Garnica
authors.forename: Carmen María
authors.initials: CM
authors.lastname: Romero-Barco
authors.forename: Blanca
authors.initials: B
authors.lastname: Panero-Lamothe
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Descalzo
authors.forename: Loreto
authors.initials: L
authors.lastname: Carmona
authors.forename: Manuel
authors.initials: M
authors.lastname: Rodríguez-Pérez
authors.forename: Antonio
authors.initials: A
authors.lastname: Fernández-Nebro
mesh_terms: D015502:Absorptiometry, Photon; D000465:Algorithms; D015519:Bone Density; D003430:Cross-Sectional Studies; D003720:Densitometry; D005260:Female; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000000981:diagnostic imaging* / Q000453:epidemiology; D018570:Risk Assessment