Comparison of Screening Strategies for Bone Mineral Density Measurement

ABSTRACT

Objective: No definite optimal strategy exists to identify candidates for bone mineral density (BMD) testing in postmenopausal women younger than 65 years. Therefore, this study aimed to compare different strategies used to identify suitable candidates for BMD testing.

Material and Methods: In total, 187 postmenopausal women aged 50–64 years without a history of low-trauma fracture were included in this cross-sectional study. Screening strategies used for BMD testing were (1) The presence of at least one risk factor, (2) A Fracture Risk Assessment Tool (FRAX®) threshold score of 10% for major osteoporotic fracture risk, and (3) A FRAX® age-dependent assessment threshold for major osteoporotic fracture risk. Cochran’s Q test was used for comparison. The agreement between the strategies was assessed using kappa statistics.

Results: The median (range) age was 57 (50-64) years. The median (range) 10-year predicted major osteoporotic fracture and hip fracture risks were 4.9% (2.3-13) and 0.4% (0.1-4.4), respectively. Furthermore, 59.4% of participants were candidates for BMD testing according to strategy (1), compared with 3.2% according to strategy (2), and 81.8% according to strategy (3) (Cochran’s Q pvalue< 0.001, p<0.05 for the 3 strategies in pairs). The value of kappa (agreement) between (2) and (1) was 0.04 and that between (2) and (3) was 0.01. The value between (1) and (3) was 0.39.

Conclusion: Three strategies used in the selection of postmenopausal women younger than 65 years for BMD testing were in disagreement. The strategy of FRAX® threshold score of 10% does not seem appropriate for BMD screening. The FRAX® age-related assessment threshold strategy may be more appropriate for BMD screening but its effectiveness in terms of treatment and cost needs to be demonstrated in further studies.