Impact on the population of different bone mineral density testing criteria and appropriateness of densitometries in the ESOSVAL cohort, Spain

Abstract

Context: There is little consensus regarding which individuals should be recommended for bone mineral density (BMD) testing, a situation that could eventually affect the appropriateness of routine clinical practice.

Objectives: The aim of this study was to estimate the impact on the population of the application of the BMD testing criteria provided by the National Osteoporosis Guideline Group (NOGG), National Osteoporosis Foundation (NOF), and Osteoporosis Canada and to assess the appropriateness of the BMD tests currently performed.

Design: A cross-sectional study was conducted using the baseline data of the ESOSVAL cohort.

Participants: Participants included 11 035 men and women aged 50 years old and over attending primary health care centers in the Valencia region, Spain (2009-2010).

Main outcome and measures: BMD testing by dual-energy X-ray absorptiometry was recorded.

Results: Of the 10 710 people included in the study, 1617 (15.1%; 95% confidence interval [CI]: 14.4-15.8) received a BMD test. When applying the NOGG criteria, BMD testing would be recommended in 17.4% (95% CI: 16.7-18.1) of individuals, whereas this percentage would rise to 74.6% (95% CI: 73.7-75.4) and 80.1% (95% CI: 79.4-80.9) when using the Osteoporosis Canada and the NOF criteria, respectively. Regarding the appropriateness of the BMD tests performed in the ESOSVAL cohort, 40.7% (95% CI: 38.3-43.1), 86.0% (95% CI: 84.3-87.7), and 82.2% (95% CI: 80.3-84.1) of individuals having a BMD test met the NOGG, NOF, and the Canadian guidelines criteria, respectively. Of the tests performed, 40.7% would be deemed as appropriate, whereas 10.7% would be considered inappropriate.

Conclusions: The impact on the population of the different recommendations is enormous, varying from 17% to 80% of the population over 50 who would be tested. Although in men it seems that a clinical rationale exists between the presence of risk factors and the rates of BMD testing, this pattern does not seem to exist in women. One in 10 of the densitometric tests performed were inappropriate according to all the guidelines.