An approach to identify rural women aged 60 to 64 for osteoporosis treatment

The US Preventive Services Task Force recently recommended that women younger than 65 years undergo a bone mineral density screening if clinical risk factors (CRFs) of a major osteoporotic fracture are ≥9.3% for a period of 10 years. We sought the most cost-effective approach to identify older, rural women who are eligible for osteoporosis treatment.

We evaluated CRFs and peripheral forearm densitometry (pDXA) in 277 rural women aged 60 to 64 years for treatment eligibility. We compared three strategies of universal screening-pDXA, CRFs, and exclusion of pDXA in specific situations (prior fracture and CRFs ≥20%)-followed by CRF evaluation with pDXA confirmation in the residual population.

Our sample showed that 37.5% of women had CRFs at a ≥9.3% cutoff threshold. Only osteoporotic pDXA values were significantly higher at this threshold. Current estrogen use was significantly associated with diminished treatment eligibility (P = 0.001). Body mass index correlated poorly with pDXA values (r = 0.12) and CRFs (r = 0.21). Although a cost-savings strategy nonsignificantly identified more women who were eligible for treatment using the three strategies (P = 0.25), significantly fewer pDXA examinations were required (P < 0.001).

Initiating treatment in rural women aged 60 to 64 years who had a prior fracture or CRFs ≥20% without pDXA confirmation, followed by pDXA evaluations in the residual population with CRFs between ≥9.3% and 20%, significantly reduced the number of pDXA examinations and the cost of screening.