title: Point-of-Care Phalangeal Bone Mineral Density Measurement Can Reduce the Need of Dual-Energy X-Ray Absorptiometry Scanning in Danish Women at Risk of Fracture.
abstract: Identifying persons with a high risk of osteoporotic fractures remains a challenge. DXA uptake in women with elevated risk of osteoporosis seems to be depending on distance to scanning facilities. This study aimed to investigate the ability of a small portable scanner in identifying women with reduced bone mineral density (BMD), and to define triage thresholds for pre-selection. Total hip and lumbar spine BMD was measured by dual-energy X-ray absorptiometry and phalangeal BMD by radiographic absorptiometry in 121 Danish women with intermediate or high 10-year fracture probability (aged 61-81 years). Correlation between the two methods was estimated using correlation coefficient (r) and Bland-Altman plots. A moderate correlation between phalangeal BMD versus total hip (r = 0.47) and lumbar spine (r = 0.51), and an AUC on 0.80 was found. The mean difference between phalangeal T score and total hip T score/lumbar spine T score was low, and ranged from -0.26 SD to -0.31 SD depending on site and reference database used for calculation of T scores, but, large variation was seen at an individual level. When applying a triage approach approx. one-third of all DXA scan could be avoided and only 6 % of women in the low-risk group would be false negatives.
authors.affiliation: National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2, 1399, Copenhagen K, Denmark. tho@niph.dk.
authors.forename: Teresa
authors.initials: T
authors.lastname: Holmberg
authors.affiliation: KORA, the Danish Institute for Local and Regional Government Research, Copenhagen, Denmark.
authors.forename: Mickael
authors.initials: M
authors.lastname: Bech
authors.affiliation: Department of Endocrinology, Hospital of Southwest Denmark, Esbjerg, Denmark.
authors.forename: Jeppe
authors.initials: J
authors.lastname: Gram
authors.affiliation: Department of Endocrinology, Odense University Hospital, Odense, Denmark.
authors.forename: Anne Pernille
authors.initials: AP
authors.lastname: Hermann
authors.affiliation: Odense Patient Data Explorative Network (OPEN), Institute of Clinical Research, University of Southern Denmark, Odense M, Denmark.
authors.forename: Katrine Hass
authors.initials: KH
authors.lastname: Rubin
authors.affiliation: Department of Endocrinology, Odense University Hospital, Odense, Denmark.
authors.forename: Kim
authors.initials: K
authors.lastname: Brixen
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015519:Bone Density; D003718:Denmark; D005188:False Negative Reactions; D005260:Female; D050278:Finger Phalanges / Q000000981:diagnostic imaging*; D006615:Hip / Q000000981:diagnostic imaging; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D000067716:Point-of-Care Testing; D011336:Probability; D012042:Registries; D018570:Risk Assessment; D012680:Sensitivity and Specificity
keywords: Bone mineral density; Dual-energy X-ray absorptiometry; Osteoporosis; Radiographic absorptiometry; Screening