Osteoporosis and imaging screening

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According to the National Osteoporosis Foundation, osteoporosis (which literally means porous bone) is quite common.  Approximately 54 million Americans live with the condition or have osteopenia (low bone mass, and a risk factor for osteoporosis).  The condition is expensive, with forecasts estimating that by 2025, osteoporosis will result in three million annual fractures and $25.3 billion in annual U.S. costs. 

Osteoporosis is a silent disease related to aging, but can also be caused by a variety of disorders including autoimmune and digestive diseases, medical procedures, cancer, neurological disorders, hormonal problems, poor diet, and certain medications, to name a few. Bone density testing is the only way to diagnose osteoporosis prior to a fracture. Thankfully, detection of osteoporosis allows for early treatment of the disease, which can help reverse some of its effects and slow the development of painful symptoms.

Bone Density Testing
The main exam used for bone density testing is dual X-ray absorptiometry, more commonly referred to as DXA or DEXA. Other tests include an ultrasound of the heel of the foot, and a QCT, a type of CT scan which gathers cross-sectional information.

The United States Preventive Services Task Force (USPSTF) and the National Osteoporosis Foundation (NOF) have different opinions on the importance of screening men and women. The NOF supports screening men at age 70 and women at 65, but the USPSTF does not recommend screening men. Regardless, those with risk factors may require screening at an earlier age.

Evaluating Risk
One way to evaluate risk is using an online tool called the FRAX calculator. This tool allows you to calculate the chance of having an osteoporotic fracture over the next decade. A 65-year-old female with no other risk factors has a 9.3 percent chance of fracture in her next 10 years of life, which is considered a reasonable threshold to use for screening.  By using the FRAX tool, patients and providers can determine which men and women meet this same threshold based on risk factors. For example, a 55-year-old female smoker whose mother had a hip fracture has about a 12 percent chance of fracture in the next 10 years, so she should undergo screening. There is some debate regarding optimal intervals for repeat screening of men and women, but when repeat testing is performed, comparison is easier if the same type of test is done.

Other Screening Tests
While debates about healthcare policy continue throughout the world, most seem to agree that prevention makes both economic and public health sense. Medical imaging can play an important role. In addition to bone density testing, the USPSTF advocates other medical imaging screening procedures based on cost-effectiveness and medical-effectiveness criteria. These tests include abdominal aortic ultrasound for aneurysm screening, mammography, and Chest CT for lung cancer screening. 

In addition, the American Cancer Society advocates Breast MRI for breast cancer screening in high risk women – those with a lifetime risk of the disease that exceeds 20 percent. Other medical imaging screening tests that are more controversial include CT colonography to screen for colon cancer, prostate ultrasound for prostate cancer, cardiac calcium scoring coronary artery disease risk assessment, and carotid ultrasound for stroke risk assessment. And while not traditionally grouped as a medical imaging procedure, retinal screening for diabetic retinopathy is now widely recommended and increasingly performed using medical photography. 

Screening and Your Practice
Given the well-established need for prevention and the role of imaging screening, one can't help but wonder, should imaging providers play a more active role in improving compliance or should screening decisions be left entirely to primary care physicians? 

Suppose a 68-year-old female smoker presents to your imaging practice for an ankle X-ray.  Do you take advantage of this encounter to assess the need for screening imaging? Take the poll and let us know what you think.

Should imaging providers play a more active role in screening decisions?

May is National Osteoporosis Month. To learn more about the condition and screening, visit www.nof.org.

Originally posted on: 5/24/2017 10:22:01 AM

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