Authors' objectives:

To provide an overview of the current state of scientific knowledge assessing the safety, efficacy and cost of bone densitometry (BD). Its impact on the prevention of osteoporotic fractures is assessed.

Authors' results and conclusions: Osteoporosis and its main clinical consequence, hip fracture, is a disorder associated with an important economic and social cost. This burden has recently increased the pressure to establish programs for screening osteoporosis mainly in perimenopausal women. There is no scientific evidence supporting the utilization of BD to screen general populations or menopausal women for the prevention of future bone fractures. The only scientific based indications at this moment are: presence of risk factors in menopausal women who consent to initiate hormone therapy with a compromise in its compliance; vertebral abnormalities in a plain Rx; chronic treatment with glucocorticoids; and a symptomatic primary hyperparathyroidism. There are invasive and non-invasive BD techniques. Non-invasive techniques are wider spread and preferred. The most common techniques are: single photon absortiometry (SPA), dual-photon absortiometry (DPA), quantitative computerized tomography (QCT), and dual energy x-ray absortiometry (DXA). This last one is, nowadays,the technique of choice due to: its low radiation dose, its superior ergonomic properties and its more affordable cost. BD has shown its efficacy in the diagnosis of osteopenia, but is not effective in predicting future fractures. Low mineral density increases the risk of fractures but, also, in elderly women there are the result of other events (ex. blindness, falls...). The promotion of a healthy lifestyle is the most cost-effective approach for the prevention of osteoporosis. Hormone therapy is effective in reducing mineral reabsorption in postmenopausal women. Calcitonin should only be considered if there are contraindications to hormone therapy and in case of idiopathic osteoporosis. Some other kind of drugs are currently proposed but they still are under clinical evaluation. The cost associated to pharmacologic treatment is the main part of the total cost of a program of prevention of osteoporosis. There is no sound scientific evidence on the efficacy of screening and treatment programs in preventing future bone fractures in the elderly.

Authors' recommendations: There is no scientific evidence to recommend the use of BD to screen general populations or menopausal women. Dual energy x-ray absortiometry (DXA) is currently considered the gold standard in the diagnosis of low bone density. Due to the technical and professional requirements of BD, this equipment should be placed in high technology or university affiliated hospitals. The current number of BD devices available in Catalonia should be enough to meet the needs of the Catalan population.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.gencat.net/salut/depsan/units/aatrm/html/en/dir393/doc7921.ht ml

Year Published: 1993

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Agencia de Qualitat i Avaluacio Sanitries de Catalunya

Contact Address: Antoni Parada, CAHTA, Roc Boronat, 81-95 (2nd floor), 08005 Barcelona, Spain, Tel. +34 935 513 928, Fax: +34 935 517 510

Contact Name: direccio@aatrm.catsalut.net / aparada@aatrm.catsalut.net

Contact Email: direccio@aatrm.catsalut.net / aparada@aatrm.catsalut.net

Copyright: Catalan Agency for Health Technology Assessment and Research