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Osteoporosis: point-of-care testing
Renee M DeHart1, English H Gonzalez
1McWhorter School of Pharmacy, Medical Center East Family Practice Residency Program, Samford University, Birmingham, AL 35229-7027, USA. rmdehart@samford.edu
Objective:
To review the literature concerning the utility of point-of-care (POC) testing devices for the diagnosis and management of osteoporosis.
Data Sources:
Articles were identified from a MEDLINE search (1993-June 2003). Additional references were obtained from cross-referencing the bibliographies of selected articles.
Study Selection And Data Extraction:
After evaluation of clinical trials and select review articles, articles comparing peripheral dual-energy absorptiometry (pDXA) or quantitative ultrasound (QUS) with central DXA (cDXA) measurements were emphasized in this analysis.
Data Synthesis:
Sensitivity for detecting osteoporosis by QUS or pDXA varies widely (range 35-75%). Using adjusted T-score cutoffs increases sensitivity to 85-95%, at the price of reducing device specificity to 23-49%. Many states require a radiology technician to perform pDXA tests.
Conclusions:
POC testing with peripheral devices should only be considered in areas with limited access to cDXA or for women who initially refuse cDXA testing. T scores of-1.0 or less with POC testing typically require further evaluation via cDXA. Many states require pDXAs to be performed by certified radiology technologists, making QUS use more feasible for pharmacists. POC testing should not be used for assessing response to osteoporosis therapy.
