Peripheral Densitometry Predicts Fracture Risk.

Heel, forearm, finger sites equally predictive.

CHICAGO -- Bone densitometry readings at the heel, forearm, and finger are all about equal in their ability to help physicians identify white women at risk of fracturing any of their hones within the next year, Kenneth G. Faulkner, Ph.D., said at the annual meeting of the American College of Obstetricians and Gynecologists.

That's the preliminary finding of the National Osteoporosis Risk Assessment study, the largest observational osteoporosis study ever conducted in the United States. The research involved more than 200,000 women.

The findings have important implications for office-based physicians. While bone densitometry measurements taken at central sites such as the hip or spine remain the best modality for diagnosing osteoporosis and its severity, the study results suggest that densitometry measurements taken at peripheral sites are acceptable for screening and identifying women who require further bone evaluation and possibly treatment, Dr. Faulkner said in an interview.

By implication, primary care physicians no longer have an excuse for not screening postmenopausal white women younger than 65 with risk factors and all women aged 65 and older regardless of risk factors, as several national specialty groups, including ACOG, have advised.

The spine is the first place that shows bone loss in postmenopausal woman. "But if you don't have access [to spinal densitometry], I'd rather see you do peripheral densitometry than nothing at all," he continued. "The conventional wisdom is, if we want to predict a patient's risk of fracturing the spine, we've got to measure bone density at the spine. But these data don't support that."

The one exception is the hip. Densitometry at the hip probably really is better at predicting hip fractures than any of the peripheral measurements, he said.