Related Experiment Videos
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
The Annals of Pharmacotherapy
|January 27, 2004
Summary
Point-of-care (POC) testing for osteoporosis using peripheral devices offers limited sensitivity and should supplement, not replace, central DXA scans. Quantitative ultrasound (QUS) may be more feasible for pharmacists due to regulatory requirements for pDXA.
Area of Science:
- Osteoporosis diagnosis and management
- Point-of-care testing (POCT)
- Bone densitometry
Background:
- Osteoporosis diagnosis relies on bone mineral density (BMD) measurements.
- Central dual-energy X-ray absorptiometry (cDXA) is the gold standard for BMD assessment.
- Limited access to cDXA necessitates evaluation of alternative diagnostic tools.
Purpose of the Study:
- To review the literature on the utility of point-of-care (POC) testing devices for osteoporosis diagnosis and management.
- To compare the effectiveness of peripheral dual-energy absorptiometry (pDXA) and quantitative ultrasound (QUS) with cDXA.
Main Methods:
- Literature search of MEDLINE (1993-June 2003) and bibliographies of selected articles.
- Evaluation of clinical trials and review articles.
- Emphasis on studies comparing pDXA or QUS with cDXA measurements.
Main Results:
- Sensitivity of QUS or pDXA for osteoporosis detection varies widely (35-75%).
- Adjusted T-score cutoffs improve sensitivity (85-95%) but decrease specificity (23-49%).
- Regulatory requirements in many states necessitate certified technicians for pDXA, favoring QUS for pharmacists.
Conclusions:
- POC testing with peripheral devices is best suited for areas with limited cDXA access or for patients refusing cDXA.
- POC test results of T-score -1.0 or less warrant further evaluation with cDXA.
- POC testing is not recommended for monitoring osteoporosis treatment response.