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Osteoporosis case finding in the general practice: phalangeal radiographic absorptiometry with and without risk factors for osteoporosis to select postmenopausal women eligible for lumbar spine and hip densitometry

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Abstract

Mass screening for osteoporosis using DXA measurements at the spine and hip is presently not recommended by health authorities. Instead, risk factor questionnaires and peripheral bone measurements may facilitate the selection of women eligible for axial bone densitometry. The aim of this study was to validate a case finding strategy for postmenopausal women who would benefit most from subsequent DXA measurement by using phalangeal radiographic absorptiometry (RA) alone or in combination with risk factors in a general practice setting. The sensitivity and specificity of this strategy in detecting osteoporosis (T-score ≤2.5 SD at the spine and/or the hip) were compared with those of the current reimbursement criteria for DXA measurements in Switzerland. Four hundred and twenty-three postmenopausal women with one or more risk factors for osteoporosis were recruited by 90 primary care physicians who also performed the phalangeal RA measurements. All women underwent subsequent DXA measurement of the spine and the hip at the Osteoporosis Policlinic of the University Hospital of Berne. They were allocated to one of two groups depending on whether they matched with the Swiss reimbursement conditions for DXA measurement or not. Logistic regression models were used to predict the likelihood of osteoporosis versus “no osteoporosis” and to derive ROC curves for the various strategies. Differences in the areas under the ROC curves (AUC) were tested for significance. In women lacking reimbursement criteria, RA achieved a significantly larger AUC (0.81; 95% CI 0.72–0.89) than the risk factors associated with patients’ age, height and weight (0.71; 95% C.I. 0.62–0.80). Furthermore, in this study, RA provided a better sensitivity and specificity in identifying women with underlying osteoporosis than the currently accepted criteria for reimbursement of DXA measurement. In the Swiss environment, RA is a valid case finding tool for patients with risk factors for osteoporosis, especially for those who do not qualify for DXA reimbursement.

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Acknowledgments

We thank Merck Sharp & Dohme-Chibret AG Switzerland for providing the digital processing system. We are grateful to all participating physicians who recruited the patients and trusted in the competence of our center, to Professor Philippe Jaeger for initiating the collaboration with Dr. Abetel and the Swiss College of Family practitioners, and to Dr. Philippe Kress for his invaluable contribution to the preparation of the manuscript.

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Authors and Affiliations

  1. Osteoporosis Policlinic, University Hospital of Berne, 3010, Berne, Switzerland

    Katharina M. Gasser, Christian Mueller, Manfred Kaufmann, Gaby Fuchs, Romain Perrelet & Kurt Lippuner

  2. Department of Social and Preventive Medicine, University of Berne, Berne, Switzerland

    Marcel Zwahlen

  3. Swiss College of Family Practitioners, Clinical Research Group of the Swiss Foundation for General Medicine, Berne, Switzerland

    Gilbert Abetel

  4. Department of Internal Medicine, University Hospital of Berne, Berne, Switzerland

    Ulrich Bürgi

Authors
  1. Katharina M. Gasser
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  2. Christian Mueller
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  7. Gilbert Abetel
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  9. Kurt Lippuner
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Corresponding author

Correspondence to Kurt Lippuner.

Appendix

Appendix

The 90 participating physicians recruiting 423 patients were: Abetel Gilbert, Orbe; Adank Christian, Lyssach; Aeschlimann Kurt, Langenthal; Affolter Ulrich, Weier i. E.; Bachmann Martin, Hindelbank; Bandi Benvenuto, Burgdorf; Bentz Laurent, Jegenstorf; Bettler Markus, Ins; Bettschen Hans Ulrich, Spiez; Bettschen Liana, Spiez; Boss Dieter Urs, Gwatt; Brügger Daniel, Laupen; Brunner Hansuli, Thun; Buchli Axel; Neuenegg; Buchli Richard, Ueberstorf; Bugnon Gérard, Liebefeld; Bugnon-Hartmann Roswitha, Bern; Burach Haefliger Helen, Nidau; Castelberg Ulrich, Aarbeg; de Vevey Pierre, Chavornay; de Vevey Maryse, Chavornay; Dettwiler Hansueli, Biel/Bienne; Egloff Stefan, Biel/Bienne; Fahrni Urs Walter, Thun; Flückiger Alex, Biel; Galland Christiane, Romainmôtier; Gehri Paul, Biel / Bienne; Glardon Michel, Tavannes; Golder Simon, Thun; Grossen Rudolf, Aeschi; Haase Serge, Thun; Hagnauer Ulrich, Thun; Hungerbuhler Philippe, Yverdon; Kammer Peter, Münsingen; Karly Michel, Orbe; Kieliger Franz, Grenchen; Kinsbergen Manus, Biel/Bienne; Kneubühler Hans-Rudolf, Steffisburg; Kohler Samuel, Münchenbuchsee; Koller-Stebler Franz, Biel; Kölliker Franz, Biel; Kreutz Helène, Thun; Lanz Markus, Wattenwil; Lasserre Bernard, Orbe; Lasserre Murielle, Orbe; Leuenberger Jean—Frédéric, Bonvillars; Luder Paul, Steffisburg; Mancini Maxime, Orbe; Marth Jürg, Biel/Bienne; Meinerzhagen Andreas, Wabern; Merz Philippe, Biel; Messerli Hans-Rudolf, Burgdorf; Michel Ernst, Bern; Mösli P.R.,Rüfenacht, Moser Ruedi, Bern; Moser Samuel, Frutigen; Müller Norbert, Frutigen; Müry Hans Rudolf, Bern; Neuenschwander Christoph, Liebefeld; Oberson Bernhard, Belp; Raaflaub Walter, Schönried; Rohrer Jörg, Bern; Rordorf Richard, Thun; Rösler Daniela, Bern; Rutishauser Andreas, Bern; Sanacare HMO Gesundheitszentrum, Bern; Schacke Stefan, Steffisburg; Schärer Hans, Aarberg; Schafroth Ulrich, Münsingen; Schmid Peter, Konolfingen; Schönenberger Peter, Belp; Schweizer Thomas, Liebefeld; Sieber Johannes, Meikirch; Siegenthaler Henri, Biel/Bienne; Stahel Peter, Sumiswald; Stöcklin Emanuel, Lengnau; Tapis Matthias, Uetendorf; Thommen Susanne, Gwatt; Tièche Marcel, Grenchen; Toth Thomas, Thun; Trachsel Christoph, Reichenbach; von Tscharner Françoise, Zimmerwald; Weiss Severin, Bern; Wildbolz Mathias, Wynigen; Witz Marc, Münchenbuchsee; Wyss Erwin, Biel/Bienne; Zulliger Urs, Hinterkappelen; Zumofen Walter A., Frutigen; Zwicky Nikolaus, Thun.

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Gasser, K.M., Mueller, C., Zwahlen, M. et al. Osteoporosis case finding in the general practice: phalangeal radiographic absorptiometry with and without risk factors for osteoporosis to select postmenopausal women eligible for lumbar spine and hip densitometry. Osteoporos Int 16, 1353–1362 (2005). https://doi.org/10.1007/s00198-005-1846-z

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