Description of Treatment/Procedure

Osteoporosis is the most common metabolic bone disorder. It is characterized by abnormalities in the amount and architectural arrangement of bone tissue which lead to impaired skeletal strength and susceptibility to fractures. In white women, osteoporosis is defined as a bone mineral density (BMD) more than 2.5 standard deviations below the mean for young, normal women. BMD is commonly measured with dual-energy x-ray absorptiometry (DXA), quantitative computed tomography (QCT), and quantitative ultrasound (QUS). Both central (hip, spine) and peripheral (wrist, calcaneus) sites may be tested.

Committee Summary

The ICSI Technology Assessment Committee finds that:

1. Osteoporosis is a significant health issue reducing quality of life and resulting in significant treatment costs
   
2. The value of preventive interventions has been proven. There is a range of possible interventions some of which can be initiated without BMD screening. The available options should be thoroughly explained to patients.
   
3. SPA, SXA, DPA, DXA, QCT, and QUS are safe procedures.
   
4. DXA is most commonly used because it allows measurements of the spine and hip and offers higher precision than other systems. Higher precision allows for repeat testing to assess the effects of treatment. QUS is more portable and less expensive but less precise than DXA. QUS may be used to encourage women toward therapy. (Conclusion Grade II)
   
5. There is insufficient evidence to support mass screening for BMD; the need for BMD testing must be determined on an individual patient basis. Testing is of value when making individual decisions about therapies in lieu of estrogen replacement therapy as well as when an individual’s decision about estrogen replacement therapy would be influenced by her knowledge of her BMD.
   
6. The value of repetitive testing for monitoring the effects of therapy or for making decisions about interventions in elderly women is poorly understood. Yearly densitometry is not clinically indicated. Decisions about when to repeat testing must be individualized based on the patient’s health status, risk status, and baseline BMD.
   
7. Each clinical center should establish their own short-term precision values.