Printer Friendly

Forearm densitometry: room in primary care practice for BMD tests.

MIAMI -- Screening for osteoporosis is practical in a primary care setting with the use of peripheral dual x-ray absorptiometry devices, according to a presentation at the annual meeting of the International Society for Clinical Densitometry.

"A single site measurement probably suffices for yes/no intervention decisions. You do just as well with forearm--if that is [the type of measurement] you have in your office--as any other single site," Dr. Michael Kleerekoper said.

Primary care physicians can use the smaller, peripheral dual x-ray absorptiometry (DXA) devices to determine if further work-up is warranted. Multiple sites are still neeeded for diagnosis of osteoporosis, but a single bone density assay is appropriate for screening. Also, forearm or heel devices are easier to use and more accurate than a blood pressure reading, said Dr. Kleerekoper, associate chair of internal medicine and director of bone and mineral metabolism and gerontology research at Wayne State University, Detroit.

"A lot of osteoporosis can be managed by a primary care physician in his or her office, and not everyone needs the sophisticated technology or the expense," he said. "It is the same as with diabetes--there are not enough specialists to treat, so it is treated in primary care offices."

But there are limitations to bone mineral density testing using smaller, portable DXA devices. For example, peripheral measures are not appropriate for follow-up or monitoring of responses to antiresorptive therapy. And assessment of risk fracture in older women (over age 70) is still better with a hip DXA scan.

Convenient and low-cost peripheral devices may be more appropriate for primary care offices, compared with the larger, more dedicated equipment that is required for hip or whole body scans, Dr. Kleerekoper said. Yet "most internists refer because the people who own the big machines tell them the little machines are no good. If you make a living doing hip and spine DXA, you will not be in a rush to promote other technologies."

Certain patient populations can benefit in particular from forearm measurements, including people with breast cancer, hyperthyroidism, or hyperparathyroidism.

In a case-control study of more than 200 newly diagnosed breast cancer patients, the cancer was associated with a proximal radius DXA Z-score greater than 1 (odds ratio, 1.98). The study included 50% white women and 50% black women. The association was independent of menopause status, age, body mass index, and use and duration of hormone therapy (Osteoporos. Int. [Epub ahead of print], Feb. 4, 2004).

Peripheral DXA also can identify patients with hyperthyroidism or hyperparathyroidism, because excess thyroid hormone has a preferential effect on the distal forearm bone. Dr. Kleerekoper routinely scans patients at the spine, hip, and forearm. If the forearm has the lowest T score, he notes on the report that the referring physician should consider parathyroid excess. "I do not diagnose them with osteoporosis--I just recommend further testing for thyroid/parathyroid abnormality."


Miami Bureau
COPYRIGHT 2004 International Medical News Group
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2004 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:Clinical Rounds
Author:McNamara, Damian
Publication:Internal Medicine News
Date:May 1, 2004
Previous Article:Worse long-term outcome: depressed patients get less benefit from joint replacement.
Next Article:Artifacts and abnormalities: computer-aided densitometry requires skilled interpretation.

Related Articles
Bone Densitometry May Mislead Physicians About Osteoporosis Care.
Peripheral Densitometry Predicts Fracture Risk.
Peripheral BMD readings may predict fractures. (Almost 40% of women Had Osterpenia).
Position Development Conference. (Special Article).
Official positions of the International Society for Clinical Densitometry.
Beyond osteoporosis: look hard for secondary causes of low BMD.
Forearm densitometry: peripheral bone density testing deemed practical in primary care.
Advances favor testing to gauge osteoporosis risk: new ICD-9 code, expanded indications for BMD tests may help detect abnormalities.
Experts advise on bone density, fracture risk.
EHRs did not improve diabetes care in study of 54 practices.

Terms of use | Copyright © 2017 Farlex, Inc. | Feedback | For webmasters