Bone Abstracts

Introduction: Dual X-ray Absorptiometry (DXA) is currently the best technique available to evaluate bone mass, enabling the diagnosis of osteoporosis, the prediction of fracture risk and monitoring.

Clinical good practices consider as preferred measuring sites the lumbar (L1–L4) and proximal femur (neck and total). The vertebral morphometry is a quantitative method for the diagnosis of vertebral fractures based on measuring vertebral heights.

There is an uneven supply of diagnostic densitometric that historically represents a significant problem for the consequences that entails, in terms of money expenditure (duplication of incorrect examinations), of credibility of the diagnostic method and, in particular, of the accuracy of the subsequent clinical management.

Objective: Contrary to the prevailing standard in our area that includes the performance of a single scan (lumbar at age <65 years and unilateral femoral at age >65 years), the benchmark operating standard at our center, designated to the diagnosis and treatment of osteoporosis, involves running contextual lumbar scans, bilateral femoral and lateral to evaluate morphometric vertebral (VFA). We conducted a prospective data collection aimed at detecting whether there are significant differences in the two approaches considering a strictly diagnostic and clinical.

Material and methods: A total of 311 consecutive unselected patients underwent DXA examination according to the extensive method (lumbar and femoral bilateral, VFA); in each case, we have also detected what would be the diagnostic conclusion if it had applied a restrictive method (DXA lumbar age <65 years or femoral age >65 years); we also researched the impact resulting from the bilateral femoral scan, compared to unilateral; finally, we measured the impact of the VFA, in addition to DXA lumbar and femoral bilateral.

Results: In our experience, the contextual execution of the DXA in two standard sites (lumbar and femoral) produces an increase in diagnostic sensitivity of 40.5%.

The simultaneous execution of DXA in the lumbar and femoral bilateral, plus vertebral morphometry, to the execution of conventional test (vertebral or femoral) induces an increase in the percentage of pathologic findings of 47.17%. There is a particularly significant increase in the evidence of severe osteoporosis (which is tripled, with the ability to document unrecognized vertebral deformities).

The impact of the two different approaches on clinical decisions resulted to be significant: we record a 34.4% increase of prescriptions of first-level antiresorptive therapy (alendronate, raloxifene) and more than doubled (130% increase) recourse to a second-level treatment (denosumab, zoledronic acid, teriparatide).

Conclusions: The availability of suitable equipment and the investment of resources (time and clinical skills) fully compatible and sustainable with the current practice allow us to apply operating standards in diagnostic densitometry that significantly increase the accuracy of the examination and its usefulness in practice, as well as the credibility of the diagnostic path.