Use of a peripheral dexa measurement for osteoporosis screening

Osteoporosis is a substantial cause of morbidity and mortality in the United States. While screening for this disease is important, few studies have evaluated the role of an osteoporosis screening device in afamily practice setting. This study evaluated the influence of a peripheral-dexa (p-dexa) heel bone mineral density (BMD) measurement and a patient education program on changes in pharmacologic treatment for suspected osteopenia or osteoporosis by primary care physicians over a 1-year follow-up.

Using a computerized database (ages 50 to 75 years), 1,927 women were identified. An invitation was mailed to register for a screening to have a p-dexa heel BMD scan done and to attend an osteoporosis prevention presentation. Medication history, age, height, weight, and risk factors for osteoporosis were collected. A follow-up chart review was carried out on women who werefound to have heel BMD T-scores of <-.6 (suggested by the World Health Organization). Date of menopause onset, pharmacotherapy for osteoporosis, calcium, vitamin D, and physician intervention were assessed.

There were 292 women (15.2%) who self registered, obtained BMD testing, and attended an educational program. Of these women, 87 (30%) had at least one risk factor for osteoporosis, in addition to menopause. Mean BMD was .489 +/- .113 gm/cm2 (normal >.42 gm/cm2). A post-screening chart review was completed in 102 women (36.6%) at greatest risk for osteoporosis based on a T-score <-.6. Following the intervention, 26 women were started on antiresorptive therapy (primarily estrogen), and three additional women had a second antiresorptive agent added to estrogen.

P-dexa heel BMD has utilityfor screening patients at riskfor osteoporosis. However, only 15% of invited women attended the screenings, and pharmacotherapy treatment did not significantly change after screening in the majority of women at riskfor osteoporosis, based on p-dexa screening.