PHB1 Efficient Strategies for Osteoporosis Testing

There are multiple screening and testing tools for osteoporosis. We need to understand the most cost-efficient way to utilize these tools to identify postmenopausal women with osteoporosis. The objective of this study was to identify efficient strategies for detecting low bone mass in postmenopausal women and estimate the incremental cost per case found.
METHODS: The study sample consists of 392 women age >50. Each participant completed the Simple Calculated Osteoporosis Risk Estimation (SCORE ^* ) (a prescreening questionnaire), and bone mineral density (BMD) levels were collected at different skeletal sites. Assumed costs were: $5 for SCORE, $35 for peripheral site (pDXA) testing at the forearm, $120 for single central (DXA) site testing at hip or spine, and $200 for multiple site DXA. An osteoporotic woman was defined as a woman with BMD < −2 SD below peak adult mean at any site.
RESULTS: The cost, efficient frontier consisted of 7 strategies ranging in cost from $33 to $189 per patient, with corresponding sensitivity of 53% to 100%. The incremental cost per case found ranged from $62.30 to $1,100. Most importantly, the current gold standard (testing all women at the hip and spine) is not on the efficient frontier.
CONCLUSION: The efficiency of osteoporosis testing can be greatly increased through the appropriate use of sequential instruments to identify postmenopausal women with osteoporosis.