M P Høiberg1, K H Rubin2, A P Hermann3, K Brixen4, B Abrahamsen5. 1. Department of Research, Hospital of Southern Norway, Kristiansand, Norway; Department of Clinical Research, University of Southern Denmark, Odense, Denmark. Electronic address: mikkelhoiberg@gmail.com. 2. OPEN, Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark, Odense University hospital, Denmark. Electronic address: krubin@health.sdu.dk. 3. Department of Medical Endocrinology, Odense University Hospital, Odense, Denmark. Electronic address: pernille.hermann@rsyd.dk. 4. Department of Medical Endocrinology, Odense University Hospital, Odense, Denmark. Electronic address: kbrixen@health.sdu.dk. 5. OPEN, Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark, Odense University hospital, Denmark; Department of Medicine, Holbæk Hospital, Holbæk, Denmark. Electronic address: b.abrahamsen@physician.dk.
Abstract
INTRODUCTION: A diagnostic gap exists in the current dual photon X-ray absorptiometry (DXA) based diagnostic approach to osteoporosis. Other diagnostic devices have been developed, but no comprehensive review concerning the applicability of these diagnostic devices for population-based screening have been performed. MATERIAL AND METHODS: A systematic review of Embase, Medline and the Cochrane Central Register for Controlled Trials was performed for population-based studies that focused on technical methods that could either indicate bone mineral density (BMD) by DXA, substitute for DXA in prediction of fracture risk, or that could have an incremental value in fracture prediction in addition to DXA. Quality of included studies was rated by QUADAS 2. RESULTS: Many other technical devices have been tested in a population-based setting. Five studies aiming to indicate BMD and 17 studies aiming to predict fractures were found. Overall, the latter studies had higher methodological quality. The highest number of studies was found for quantitative ultrasound (QUS). The ability to indicate BMD or predict fractures was moderate to minor for all examined devices, using reported area under the curve (AUC) of Receiver Operating Characteristic curves values as standard. CONCLUSIONS: Of the methods assessed, only QUS appears capable of perhaps replacing DXA as standalone examination in the future whilst radiographic absorptiometry could provide important information in areas with scarcity of DXA. QUS may be of added value even after DXA has been performed. Evaluation of proposed cutoff-values from population-based studies in separate population-based cohorts is still lacking for most examination devices.
INTRODUCTION: A diagnostic gap exists in the current dual photon X-ray absorptiometry (DXA) based diagnostic approach to osteoporosis. Other diagnostic devices have been developed, but no comprehensive review concerning the applicability of these diagnostic devices for population-based screening have been performed. MATERIAL AND METHODS: A systematic review of Embase, Medline and the Cochrane Central Register for Controlled Trials was performed for population-based studies that focused on technical methods that could either indicate bone mineral density (BMD) by DXA, substitute for DXA in prediction of fracture risk, or that could have an incremental value in fracture prediction in addition to DXA. Quality of included studies was rated by QUADAS 2. RESULTS: Many other technical devices have been tested in a population-based setting. Five studies aiming to indicate BMD and 17 studies aiming to predict fractures were found. Overall, the latter studies had higher methodological quality. The highest number of studies was found for quantitative ultrasound (QUS). The ability to indicate BMD or predict fractures was moderate to minor for all examined devices, using reported area under the curve (AUC) of Receiver Operating Characteristic curves values as standard. CONCLUSIONS: Of the methods assessed, only QUS appears capable of perhaps replacing DXA as standalone examination in the future whilst radiographic absorptiometry could provide important information in areas with scarcity of DXA. QUS may be of added value even after DXA has been performed. Evaluation of proposed cutoff-values from population-based studies in separate population-based cohorts is still lacking for most examination devices.
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Authors: Kara B Anderson; Monica C Tembo; Sophia X Sui; Natalie K Hyde; Pamela G Rufus; Julie A Pasco; Mark A Kotowicz; Kara L Holloway-Kew Journal: Bone Rep Date: 2021-07-08