Comparing screening methods for osteoporosis.

Recently, much has been published about osteoporosis and the suspected vast numbers of patients who are undiagnosed or at risk. Various groups, including the US Preventative Services Task Force and The National Osteoporosis Foundation, have attempted to highlight the recommendations regarding who and when to screen. We know that for a screening test to be effective, not only must it predict morbidity far enough in advance that something can be done but it also must be widely available and cost effective. There are several methods of screening with varying sensitivity and specificity for identifying people at risk for osteoporotic fracture. After an examination of all available approved testing methods, it seems that dual-energy x-ray absorptiometry (DEXA) and calcaneal ultrasound best predict patients at risk for fracture. However, because of the length of time needed to demonstrate bone mineral changes and the small magnitude of these changes, DEXA seems to be the most cost-effective method to follow patients who are receiving treatment.