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Application of a triage approach to peripheral bone densitometry reduces the requirement for central DXA but is not
Elizabeth J Harrison1, Judith E Adams
1Clinical Radiology, Imaging Science and Biomedical Engineering, The University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT, UK.
Insights
A new triage method using peripheral DXA scans effectively identifies osteoporosis risk in post-menopausal women. However, it proved impractical due to high costs and misclassification, suggesting a need for more cost-effective alternatives.
Area of Science:
- Osteoporosis diagnosis and management.
- Medical imaging and risk assessment.
Background:
- Peripheral dual-energy X-ray absorptiometry (pDXA) offers a potential alternative to central DXA for osteoporosis screening.
- A triage approach aims to stratify patients into high-treat, medium-refer, or low-reassure risk categories.
Purpose of the Study:
- To evaluate the effectiveness of a triage approach using pDXA measures and risk indices for osteoporosis risk stratification.
- To compare the performance and cost-effectiveness of different peripheral scanners and risk indices.
Main Methods:
- 207 post-menopausal women underwent central DXA and peripheral calcaneal scans using GE Lunar Achilles and PIXI scanners.
- Four risk indices were calculated from demographic data.
- Combination algorithms of peripheral measures and risk indices were developed and tested using a triage approach.
Main Results:
- Peripheral measures, risk indices, and combination algorithms demonstrated good accuracy in identifying osteoporosis risk (ROC areas: 0.67-0.82).
- The PIXI scanner combined with the OSIRIS risk index showed the best performance, minimizing misclassification and reducing central DXA referrals to 36%.
- Implementing this triage approach was significantly more expensive (263%) than universal central DXA screening.
Conclusions:
- The triage approach is effective in identifying women at risk of osteoporosis.
- The high cost and potential for unnecessary treatment of non-osteoporotic individuals make the current triage method impractical.
- Alternative, more cost-effective screening strategies are needed for osteoporosis detection.
Abstract:
A method proffered for the interpretation of measurements from peripheral dual energy X-ray absorptiometry (pDXA) is a triage approach to stratify patients into one of three risk categories; (i) high-treat, (ii) medium-refer for central DXA and (iii) low-reassure. The aim of this study was to apply the triage approach to measures from peripheral scanners and risk indices and stratify patients into one of three risk categories (i), (ii) or (iii). 207 post-menopausal women had central DXA from which they were categorised as non-osteoporotic or osteoporotic. Additional peripheral scans of the left calcaneus were performed on three scanners (GE Lunar Achilles and PIXI, McCue CubaClinical). From demographic details four risk indices were calculated and algorithms combining measures from peripheral scanners and one risk index were obtained. All peripheral measures, risk indices and combination algorithms were good at identifying women at risk of osteoporosis (ROC areas: 0.67-0.82). Each tool stratified varying numbers of osteoporotic and non-osteoporotic women into each risk category using the triage approach. One combination algorithm (PIXI & osteoporosis indices of risk (OSIRIS)) performed best by minimising misclassification (10% non-osteoporotic, 10% osteoporotic) and reducing requirement for central DXA to 36%. However the cost of implementing the triage approach for PIXI & OSIRIS was greater (263%) than central DXA (100%) scanning all women. Although the triage approach was an effective tool at identifying women at risk of osteoporosis the unnecessary treatment of non-osteoporotic women in the high risk category make it impractical. Therefore an alternative more cost-effective method has been suggested.
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