Interest of a prescreening questionnaire to reduce the cost of bone densitometry.

摘要: Bone mineral density (BMD) measurement is widely recognized as the best single tool to identify patients with a high lifetime risk of developing an osteoporosis-related fracture. However, cost/benefit value screening whole population has been repeatedly challenged and demonstrated be rather poor. In many countries, BMD scan not or no longer reimbursed because lack validated criteria who should benefit from this procedure. Based on proposals nationwide expert panel, simple questionnaire identifying historical, clinical behavioral factors for osteoporosis was developed. The aim study assess diagnostic accuracy proposed criteria; determine extent which could useful optimizing use densitometry tests; and, more specifically, estimate costs per osteoporotic osteopenic patient detected. For purpose, we applied 3998 consecutive individuals at least 20 years old, both genders, either consulting spontaneously referred outpatient center. measured by dual-energy X-ray absorptiometry (DXA) lumbar spine hip (both total femoral neck). Diagnostic accuracies were evaluated through measures sensitivity, specificity, positive negative predictive values. After determining benchmark age, different strategies compared in order most cost-effective one terms cost According WHO operational definition (T-score <-2.5), 31% subjects classified sites. If only had scans, 33.3% measurements would have avoided. Among those, less than 5% missclassified they did up 23% considered On other hand, recommended test, small fraction identified correctly (the values varied 11.3% 34.8% any site). first setting, suggested seem chiefly excluding do need DXA selecting patients. When aged 61 more, rose 15.1% (total hip) 42.9% (any site), whereas corresponding set 93% 68.6%. comparison, mass scenario estimated (costs associated procedure) detected sites reduced 9% (59.4 instead 65.3 Euros) if indications are taken into account prescreening And when women over age 60 these further 50.6 Euros, representing decrease. Then, strategy based concomitantly age-selective criterion represent promising way toward rational measurement.