Funding: This study was supported by Servier Laboratories, Hawthorn, Vic., Australia. Dr Davis is an Australian NHMRC Principal Research Fellow (Grant no. 490939).
Comparison of plain vertebral X-ray and dual-energy X-ray absorptiometry for the identification of older women for fracture prevention in primary care
Article first published online: 17 JAN 2013
© 2012 The Authors; Internal Medicine Journal © 2012 Royal Australasian College of Physicians
Internal Medicine Journal
Volume 43, Issue 1, pages 38–45, January 2013
How to Cite
Robinson, P. J., Bell, R. J., Lanzafame, A., Segal, L., Kirby, C., Piterman, L. and Davis, S. R. (2013), Comparison of plain vertebral X-ray and dual-energy X-ray absorptiometry for the identification of older women for fracture prevention in primary care. Internal Medicine Journal, 43: 38–45. doi: 10.1111/j.1445-5994.2012.02930.x
Conflict of interest: Dr Alfred Lanzafame is an employee of Servier Laboratories.
- Issue published online: 17 JAN 2013
- Article first published online: 17 JAN 2013
- Accepted manuscript online: 29 AUG 2012 10:25PM EST
- Manuscript Accepted: 26 JUL 2012
- Manuscript Received: 21 NOV 2011
- Servier Laboratories
- Australian NHMRC Principal Research. Grant Number: 490939
- vertebral fracture;
- fracture prevention;
- bone mineral density
Recently, the dual-energy X-ray absorptiometry (DXA) diagnostic cut-off (T-score) for Australian Pharmaceutical Benefits Scheme (PBS) supported primary fracture prevention therapy with alendronate for older women (>70 years) has been changed from −3.0 to −2.5.
To examine the impact of the expanded criteria for PBS-supported fracture prevention therapy in older women on case finding and cost.
One thousand, nine hundred and eighty-three women, median age 76 years, not previously known to have low bone mineral density by DXA or a vertebral fracture underwent DXA scanning and a thoracolumbar X-ray. A woman was considered eligible for fracture prevention therapy if she had a T-score ≤−2.5 at the femoral neck and/or the lumbar vertebrae (two to four) or at least one vertebral fracture of ≥20% deformity.
Seven hundred and forty-six women (37.6%) met the new criteria as a case for PBS-subsidised fracture prevention therapy. Four hundred and thirty-one (21.7%) had a T-score ≤−2.5 on DXA compared with 10.6% (n = 210) with a T-score ≤−3.0. Four hundred and eighty-three (24.4%) had at least one vertebral fracture. Only 8.5% (n = 168) had both a T-score ≤−2.5 and a prevalent vertebral fracture. The cost per case found by DXA equated to $460 compared with $398 for screening by thoracolumbar X-ray.
The use of either DXA or X-ray will identify approximately two-thirds of women aged 70 years and over who would be eligible for fracture prevention. The use of X-ray would identify a marginally larger number of women and at lower financial cost but involve substantially greater radiation exposure.