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Bone densitometry said to belong in primary care.(Gynecology)
SAN FRANCISCO -- Measuring bone mineral density in older patients is as justifiable as measuring lipids, Dennis M. Black, Ph.D., said at a meeting on osteoporosis sponsored by the University of California, San Francisco.
Lipid testing and treatment for high cholesterol is accepted as an integral part of primary care, but bone densitometry and treatment for low bone density aren't as readily accepted, said Dr. Black, professor of epidemiology and biostatistics at the university. That's partly because measurements and treatments for osteoporosis came along well after tests and treatments for heart disease and its risk factors, he explained.
By the numbers, the value of bone density testing stacks up nicely against the value of lipid testing. Studies have shown that people with cholesterol measurements in the highest quartile have four times the risk for heart disease compared with people whose cholesterol measurements are in the lowest quartile, Dr. Black said. Stratifying hip bone density by quartile, the risk for hip fracture increases 10-fold in people whose bone density is the lowest quartile compared with those in the highest quartile.
Heart disease risk increases from about 0.5% in the lowest low-density lipoprotein (LDL) quartile to about 4% in the highest lipid quartile. Hip fracture risk increases from about 0.5% in the highest quartile of hip bone density to about 10% in the quartile with the least hip bone density.
Cost-effectiveness compares well, too, he added. Screening lipid levels in a 52-year-old woman and treating her for an LDL level greater than 160 mg/dL costs about $400,000 per quality-adjusted life-year. Screening bone density in a 65-year-old woman and treating her with bisphosphonates for a T-score of -2.5 (suggesting osteoporosis) costs about $30,000 per quality-adjusted life-year, "which is considered cost-effective," Dr. Black said.
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