Fortnightly Review: Bone densitometry in clinical practice

BMJ 1995;310:1507-1510 (10 June)

Education and debate

Fortnightly Review: Bone densitometry in clinical practice

J E Compston, honorary consultant physician,^a C Cooper, reader in rheumatology,^b J A Kanis, professor of human metabolism and clinical biochemistry ^c

^a Department of Medicine, University of Cambridge Clinical School, Addenbrooke's Hospital, Cambridge CB2 2QQ, ^b Medical Research Council Environmental Epidemiology Unit, Southampton General Hospital, Southampton SO16 6YD, ^c Department of Human Metabolism and Clinical Biochemistry, University of Sheffield Medical School, Sheffield

Correspondence to: Dr Compston.

Summary points

Osteoporosis is a major health problem in the elderly population. It causes more than 150000 fractures each year in the United Kingdom with an estimated cost of pounds sterling742 million
Bone mass is a major determinant of risk of fracture and can be assessed by non-invasive techniques such as dual energy x ray absorptiometry
Densitometric criteria based on standard deviation scores expressed in relation to reference values in premenopausal women (T scores) provide diagnostic categories from which thresholds for prevention and treatment can be defined on the basis of risk of fracture
Population based screening for low bone mass in perimenopausal women cannot at present be justified. In clinical practice, however, bone densitometry has an important role in the diagnosis of osteoporosis in high risk groups and in the monitoring of treatment in some patients
For these indications, it is estimated that about 175 bone scans per 100000 population would be needed annually, requiring an annual expenditure for the average health district of pounds sterling25200
At present, bone densitometry resources in the United Kingdom are inadequate to meet these needs. There is an urgent need to improve existing facilities so that effective strategies for the prevention and treatment of osteoporosis in clinical practice can be implemented

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