Two for the Price of One

I've always been a girl with an eye for a bargain, so that must be why I chose 'Opportunistic Screening for Osteoporosis Using Abdominal Computed Tomography Scans Obtained for Other Indications,' in Annals of Internal Medicine out of the four studies Rick and I discuss on this week's PodMed. The study is extremely appealing to me as it takes data from routine abdominal CT scans and uses it to screen for osteoporosis, hopefully eventually in lieu of DXA scanning or alternative testing for the bone-thinning condition, but here in comparison to it.  Lo and behold, looks like this is a reasonable strategy likely to appeal to all stakeholders.  What exactly did they do?

Almost 2000 adults who underwent both abdominal CT scanning and DXA scanning within six months of each other were studied.  DXA scans categorized patients as having osteoporosis, osteopenia, or normal bone mineral density. Retrospectively analyzed abdominal CT data obtained for colorectal screening was used to stratify patients into the same categories but also assess the presence of compression fractures at the first lumbar vertebral level.

CT was 90% sensitive and more than 90% specific for distinguishing osteoporosis from osteopenia or normal bone mineral density.  Interestingly, 119 patients with at least one moderate to severe vertebral fracture were classified as not having osteoporosis on DXA scanning.  Use of contrast did not impact CT results with regard to bone mineral density.

So why do I love this study?  As I already stated, I'm very fond of two-fers.  If it's possible to kill two birds with one stone I'm all for it.  Clearly, advantages of using CT scans obtained for other purposes are multiple:  there's less radiation exposure for patients, they only need to come in once for their study, and they only have one co-pay rather than two.  Systemic benefits are substantial as well: no additional software, machines, or personnel are necessary, and outlays under Medicare for routine screening should decline.

Osteoporosis, of course, is a substantial problem worldwide, predisposing people as they age to fractures secondary to falling, and that well-known trajectory to death.  Since we're successfully dealing with so many diseases and conditions, our worldwide population of people in their 80s and beyond is growing, yet rates of osteoporosis screening remain fairly low, even in resource-rich areas of the world like the United States.  Indeed, this article cites osteoporosis screening rates of just over half of all Medicare eligible females and states that 80% of those who've had an osteoporosis related fracture do not have bone mineral density assessment or receive medications for the condition.  Finally, it's worth mentioning that the condition affects men as well, particularly those aforementioned octogenarians, and that screening rates for them are also low.

Seems to me that policymakers are also going to been keenly interested in studies such as this one, that can result in better care as well as cost savings.  A win-win!

Other topics this week include glutamine and antioxidants in the ICU in the New England Journal of Medicine, chronic kidney disease predictors in Annals also, and a  link between childhood migraines and infantile colic in JAMA.  Until next week, y'all live well.

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Two for the Price of One | jhublogs
April 22, 2013 at 10:52 am

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Stephen in Florida May 20, 2013 at 8:41 pm

This opportunistic screening for osteoporosis seems like a really great idea! From what I have read and researched, the very first signs of osteoporosis could easily be that fractured hip or even the development of the widow's hump. Obviously, this would mean that the disease had been in place for some time and has caused significant weakness to the bone structure. I hope they implement this practice in more places. Just to let you know, I tried commenting here earlier but something went wrong I guess. I think this was a really informative post, and I wanted to thank you for sharing!

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