Excessive osteoporosis screening in women under 65 years: a cross-sectional study

María de las Nieves Ganiele; Sergio Adrián Terrasa; Karin Silvana Kopitowski

doi:10.18294/sc.2016.841

Excessive osteoporosis screening in women under 65 years: a cross-sectional study

María de las Nieves Ganiele Médica de familia. Médica asociada. Docente, Departamento de Medicina, Instituto Universitario del Hospital Italiano de Buenos Aires, Argentina. , Sergio Adrián Terrasa Médico de familia. Investigador Formado. Médico de Planta, Servicio de Medicina Familiar y Comunitaria, Hospital Italiano de Buenos Aires. Docente, Departamento de Salud Pública, Instituto Universitario del Hospital Italiano de Buenos Aires. Argentina. , Karin Silvana Kopitowski Médica de familia. Jefa, Servicio de Medicina Familiar y Comunitaria, Hospital Italiano de Buenos Aires. Directora, Departamento de Investigación, Instituto Universitario del Hospital Italiano de Buenos Aires, Argentina.

Received: 12 January 2016, Accepted: 20 June 2016, Published: 4 October 2016

https://doi.org/10.18294/sc.2016.841

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Abstract

Overuse of osteoporosis screening in women at low risk of fracture may lead to overdiagnosis, inappropriate treatment and medicalization. The objective of this work was to estimate the proportion of women aged 45 to 64 enrolled in a private health insurance plan in Buenos Aires undergoing hip dual-energy x-ray absorptiometry (DXA) in 2011 without meeting osteoporosis screening criteria. In this cross-sectional study, 4310 women of this age range that had undergone a hip DXA were identified. A randomly selected sub-group of 401 women was then assessed for the presence of risk factors for osteoporosis and complete data were retrieved for 178 women. Appropriate screening was defined by two criteria: 1) having a 10-year fracture risk higher than that of a 65-year old woman (estimated using the FRAX® tool); 2) having at least one risk factor for fracture. It was found that 86.5% of the women who underwent hip DXA did not exceed the minimum 10-year fracture risk threshold required for screening; 5.8% of them had osteoporosis and 61.0% osteopenia. According to the second criterion, 49.4% had no risk factors, 3.4% of these women had osteoporosis and 62.5% osteopenia. The results show that at least half the women screened did not meet osteoporosis screening criteria.

Keywords: Osteoporosis, Mass Screening, Health Services Misuse, Argentina

References

1. Schurman L, Bagur A, Claus-Hermberg H, Messina OD, Negri AL, Sánchez A, et al. Guías 2012 para el diagnóstico, la prevención y el tratamiento de la osteoporosis. Medicina (Buenos Aires). 2013;73(1):55-74.

2. World Health Organization. What evidence is there for the prevention and screening of osteoporosis? [Internet]. Copenhagen: WHO; 2006 [citado 18 may 2015]. Disponible en: http://goo.gl/llxYlj.

3. Spivacow FR, Sánchez A. Epidemiology, costs, and burden of osteoporosis in Argentina. Archives of Osteoporosis. 2010;5(1):1-6.

4. Consensus Development Conference. Diagnosis, prophylaxis and treatment of osteoporosis. American Journal of Medicine. 1993;94(6):646-650.

5. Kanis JA, Melton LJ, Christiansen C, Johnston CC, Khaltaev N. The diagnosis of osteoporosis. Journal of Bone and Minereral Research. 1994;9(8):1137-1141.

6. National Osteoporosis Foundation. Clinician's guide to prevention and treatment of osteoporosis. Washington DC: National Osteoporosis Foundation; 2014.

7. U.S. Preventive Services Task Force. Screening for osteoporosis: U.S. preventive services task force recommendation statement. Annals of Internal Medicine. 2011;154(5):356-364.

8. Qaseem A, Snow V, Shekelle P, Hopkins R Jr, Forciea MA, Owens DK, Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Pharmacologic treatment of low bone density or osteoporosis to prevent fractures: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. 2008;149(6):404-415.

9. Lim LS, Hoeksema LJ, Sherin K, ACPM Prevention Practice Committee. Screening for osteoporosis in the adult U.S. population: ACPM position statement on preventive practice. American Journal of Preventive Medicine. 2009;36(4):366-375.

10. Kanis JA, Oden A, Johansson H, McCloskey E. FRAX(r) y la evaluación de la probabilidad de fractura: introducción. Revista Metabolismo Óseo y Mineral. 2010;8(1):15-18.

11. Claus-Hermberg H, Bagur A, Messina OD, Negri AL, Schurman L, Sánchez A. FRAX(r): un nuevo instrumento para calcular el riesgo absoluto de fracturas a 10 años. Medicina (Buenos Aires). 2009;69(5):571-575.

12. FRAX(r) WHO Fracture Risk Assessment Tool [Internet]. World Health Organization Collaborating Centre for Metabolic Bone Diseases [citado 15 may 2015]. Disponible en: http://goo.gl/CPiWYR

13. The North American Menopause Society. Management of osteoporosis in postmenopausal women: 2006 position statement of the NAMS. Menopause. 2006;13:340-367.

14. Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, et al. 2010 clinical practice guidelines for the diagnosis and management of OP in Canada. CMAJ. 2010;182(17):1864-1873.

15. Moniyan R, Cassels A. Selling sickness: How the world's biggest pharmaceutical companies are turning us all into patients. New York: Nation Books; 2006.

16. Järvinen TLN, Michaëlsson K, Jokihaara J, Collins GS, Perry TL, Mintzes B, et al. Overdiagnosis of bone fragility in the quest to prevent hip fracture. BMJ. 2015;350:h2088.

17. Järvinen TLN, Sievänen H, Khan KM, Heinonen A, Kannus P. Shifting the focus in fracture prevention from osteoporosis to falls. BMJ. 2008;336:124-126.

18. Ortuño M, Clavijo M, García Allende N, Popoff F, Aizpurua F, Izcovich A, Catalano H. Uso y sobreuso de la densitometría ósea como método de screening de osteoporosis. Revista Argentina de Medicina. 2013;1(1):13-16.

19. Schnatz PF, Marakovits KA, Dubois M, O'Sullivan DM. Osteoporosis screening and treatment guidelines: are they being followed? Menopause. 2011; 18:1072-1078.

20. Gérvas J, Pérez Fernández M. Cribados: una propuesta de racionalización. Gaceta Sanitaria. 2013;27:372-373.

21. Reid R, Haggerty J, McKendry R. Defusing the confusion: Concepts and measures of continuity of care [Internet]. Ottawa: Fondation Canadienne de la Recherche sur les Services de Santé; 2002 [citado 10 may 2015]. Disponible en: http://goo.gl/4e5NPB.

22. Organización Panamericana de la Salud. Buenas Prácticas Clínicas: Documento de las Américas. [Internet]. OPS/OMS; 2005 [citado 10 may 2015]. Disponible en: https://goo.gl/T1rxWl

23. Hurtado I, Sanfélix-Gimeno G, Baixauli-Pérez C, Peiró S, Sanfélix-Genovés J. Impact on the population of different bone mineral density testing criteria and appropriateness of densitometries in the ESOSVAL cohort, Spain. Journal of Clinical Endocrinology and Metabolism. 2014;99(1):142-150.

24. U.S. Department of Health and Human Services. Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Office of the Surgeon General; 2004.

25. Kanis J, Johnell O, Oden A, Dawson A, De Laet C, Jonsson B. Ten year probabilities of osteoporotic fracture according to BMD and diagnostic thresholds. Osteoporosis International. 2001;12(12):989-995.

26. Zárate A, Saucedo R. Controversia sobre el manejo de la osteopenia. Acta Médica Grupo Angeles. 2003;1(4):241-242.

27. Sosa Henríquez M, Gómez de Tejada Romero MJ. El término osteopenia y el riesgo de fractura. Anales de Medicina Interna (Madrid). 2006;23(4):151-152.

28. Khosla S, Melton L. Osteopenia. New England Journal of Medicine. 2007;356:2293-2300. doi: 10.1056/NEJMcp070341.

29. Galán I, Rodríguez Artalejo F, Zorrilla B. Reproducibilidad de un cuestionario telefónico sobre factores de riesgo asociados al comportamiento y las prácticas preventivas. Gaceta Sanitaria. 2004;18:118-128.