Skip to main content
Log in

Requirements for DXA for the management of osteoporosis in Europe

  • Position Paper
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

The availability of dual energy X-ray absorptiometry (DXA) varies markedly in different countries. There is, however, little information to indicate the optimal requirements for this technology. The principal aim of this study was to estimate the requirements for DXA in Europe for the assessment and treatment of osteoporosis. Three assessment scenarios were chosen. The first envisaged screening of all women with DXA at the age of 65 years. A second scenario comprised a screening programme based on the identification of clinical risk factors with the selective addition of BMD tests in those close to an intervention threshold. The third scenario envisaged a case finding strategy where women aged 65 years were identified on the basis of risk factors and referred for DXA. Requirements for women aged more than 65 years were amortised over a 10-year period. A secondary aim was to estimate the number and cost of osteoporotic fractures in Europe. The requirements for DXA in assessment ranged from 4.21 to 11.21 units/million of the population. The most efficient assessment scenario was the use of clinical risk factors with the selective use of BMD. With this scenario, an additional 6.39 units/million would be required to monitor treatment giving a total requirement of 10.6 units/million. In 2000, the number of osteoporotic fractures was estimated at 3.79 million, of which 0.89 million were hip fractures (179,000 hip fractures in men and 711,000 in women). The total direct costs were estimated at €31.7 billion (£21.165 billion), which were expected to increase to €76.7 billion (£51.1 billion) in 2050 based on the expected changes in the demography of Europe.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Kanis JA, Johnell O, De Laet C et al. (2002b) International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res 17:1237–1244

    PubMed  Google Scholar 

  2. European Commission (1998) Report on osteoporosis in the European Community—action on prevention. Luxembourg Office for Official Publications of the European Communities, 1998, pp 112

  3. Kanis JA, Johnell O, Oden A et al. (2000) Long term risk of osteoporotic fracture in Malmo. Osteoporosis Int 11:669–674

    Article  Google Scholar 

  4. Johnell O, Kanis JA, Jonsson B, Oden A, Johansson H, De Laet C (2005) The burden of hospitalised fractures in Sweden. Osteoporos Int DOI 10.1007/s00198-004-1686-2

  5. Delmas PD (2002) Treatment of postmenopausal osteoporosis. Lancet 359:2018–2026

    Article  CAS  PubMed  Google Scholar 

  6. Cuddily MT, Gabriel SE, Crowson CS, Atkinson E (2000) Osteoporosis management in postmenopausal women after low impact distal forearm fracture: a missed opportunity. J Bone Miner Res 15 (suppl 1):187 (abstract)

    Google Scholar 

  7. Kamel HK, Hussain MS, Tariq S, Perry MM, Maely JE (2000) Failure to diagnose and treat osteoporosis in elderly patients hospitalised with hip fracture. Am J Med 109:338–339

    Article  CAS  PubMed  Google Scholar 

  8. Torgerson DJ, Dolan P (1998) Prescribing by general practitioners after an osteoporotic fracture. Ann Rheum Dis 57:378–379

    CAS  PubMed  Google Scholar 

  9. Briancon D, de Gaudemar J-B, Forestier R (2004) Management of osteoporosis in women with peripheral osteoporotic fractures after 50 years of age: a study of practices. Joint Bone Spine 71:128–130

    Article  PubMed  Google Scholar 

  10. Panneman MJM, Lips P, Sen SS, Herings RMC (2004) Undertreatment with anti-osteoporotic drugs after hospitalisation for fracture. Osteoporos Int 15:120–124

    Article  Google Scholar 

  11. Kanis JA, Gluer CC, for the Committee of Scientific Advisors, International Osteoporosis Foundation (2000) An update on the diagnosis and assessment of osteoporosis with densitometry. Osteoporos Int 11:192–202

    Article  CAS  PubMed  Google Scholar 

  12. National Osteoporosis Foundation (1998) Physician’s guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation, Washington D.C., pp 1–38

  13. US Preventive Services Task Force (2003) Screening for osteoporosis in postmenopausal women. Office of Disease Prevention and Health Promotion, Washington D.C.

  14. Kanis JA (2002) Diagnosis of osteoporosis and assessment of fracture risk. Lancet 359:1929–1936

    Article  PubMed  Google Scholar 

  15. Johansson H, Oden A, Johnell O, Jonsson B, De Laet C, Oglesby A, McCloskey EV, Kayan K, Jalava T, Kanis JA 2004 Optimisation of BMD measurements to identify high risk groups for treatment—a test analysis. J Bone Miner Res 19:906–913

  16. Kanis JA, Johansson H, Oden A, Johnell O, De Laet C, Melton LJ, Tenenhouse A, Reeve J, Silman AJ, Pols HAP, Eisman JA, McCloskey EV, Mellstrom D (2004) A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res 19:893–899

    PubMed  Google Scholar 

  17. Kanis JA, Johnell O, Oden A, Borgstrom F, Johansson H, De Laet C, Jonsson B (2005) Intervention thresholds for osteoporosis in men and women. A study based on data from Sweden. Osteoporos Int 16:6–14

    Google Scholar 

  18. Kanis JA, Delmas P, Burckhardt P, Cooper C, Torgerson D on behalf of the EFFO (1997) Guidelines for the diagnosis and management of osteoporosis. Osteoporos Int 7:390–406

    CAS  PubMed  Google Scholar 

  19. Royal College of Physicians (1999) Osteoporosis: clinical guidelines for prevention and treatment. RCP, London

  20. Royal College of Physicians (2000) Osteoporosis: clinical guidelines for prevention and treatment. Update on pharmacological interventions and an algorithm for management. RCP, London

  21. United Nations Population Division (2003) World population prospects: the 2002 revision and world urban prospects. Population Division of the Department of Economic and Social Affairs of the UN Secretariat

    Google Scholar 

  22. Seeley DG, Browner WS, Nevitt MC, Genant HK, Scott JC, Cummings SR for the Study of Osteoporotic Fractures Research Group (1991) Which fractures are associated with low appendicular bone mass in elderly women? Ann Int Med 115:837–842

    Google Scholar 

  23. Kanis JA, Oden A, Johnell O, Jonsson B, De Laet C, Dawson A (2002) The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int 12:417–424

    Article  Google Scholar 

  24. Baron JA, Barrett J, Malenka D et al. (1994) Racial differences in fracture risk. Epidemiology 5:42–47

    CAS  PubMed  Google Scholar 

  25. Melton LJ, Crawson CS, O’Fallon WM (1999) Fracture incidence in Olmsted County, Minnesota: comparison of urban and with rural rates and changes in urban rates over time. Osteoporos Int 9:29–37

    Article  PubMed  Google Scholar 

  26. Sanders KM, Nicholson GC, Ugoni AM, Pasco JA, Seeman E, Kotowicz MA (1999) Health burden of hip and other fractures in Australia beyond 2000. Projections based on the Geelong Osteoporosis study. Med J Aust 170:467–470

    CAS  PubMed  Google Scholar 

  27. Singer BR, McLauchlan CJ, Robinson CM, Christie J (1998) Epidemiology of fracture in 15,000 adults. The influence of age and gender. J Bone Joint Surg 80B:234–238

    Google Scholar 

  28. Felsenberg D, Silman AJ, Lunt M, Ambrecht G, Ismail AA, Finn JD, Cockerill WC, Banzer D, Benevolenskaya LI, Bhalla A, Bruges Armas J, Cannata JB, Cooper C, Dequeker J, Eastell R, Ershova O, Felsch B, Gowin W, Havelka S, Hoszowski K, Jajic I, Janot J, Johnell O, Kanis JA, Kragl G, Lopez Vaz A, Lorenc R, Lyritis G, Masaryk P, Matthis C, Miazgowski T, Parisi G, Pols HAP, Poor G, Raspe HH, Reid DM, Reisinger W, Scheidt-Nave C, Stepan J, Todd C, Weber K, Woolf AD, Reeve J, O’Neill TW (2002) Incidence of vertebral fracture in Europe: results from the European Prospective Osteoporosis Study EPOS. J Bone Miner Res 17:716–724

    PubMed  Google Scholar 

  29. Elffors L, Allander E, Kanis JA, Gullberg B, Johnell O, Dequeker J, Dilzen G, Gennari C, Lopez-Vaz AA, Lyritis G, Mazzuoli GF, Miravet L, Passeri M, Perez Cano R, Rapado A, Ribot C (1994) The variable incidence of hip fracture in Southern Europe. The MEDOS Study. Osteoporos Int 4:253–263

    CAS  PubMed  Google Scholar 

  30. Johnell O, Gullberg B, Kanis JA (1997) The hospital burden of vertebral fracture in Europe: a study of national register sources. Osteoporos Int 7:138–144

    CAS  Google Scholar 

  31. Dolan P, Torgerson DJ (1998) The cost of treating osteoporosis in the United Kingdom female population. Osteoporos Int 8:611–617

    Article  CAS  PubMed  Google Scholar 

  32. Kanis JA, Brazier JE, Stevenson M et al. (2002a) Treatment of established osteoporosis: a systematic review and cost utility analysis. Health Technology Assessment 6:1–146

    CAS  Google Scholar 

  33. Melton LJ, Gabriel SE, Crowson CS, Tosteson ANA, Johnell O, Kanis JA (2003) Cost equivalence of different osteoporotic fractures. Osteoporos Int 14:383–388

    Article  PubMed  Google Scholar 

  34. Borgstrom F, Johnell O, Kanis JA, Jonsson B (2004) Hip fracture probability and ability to pay for treatment: a worldwide perspective. Osteoporos Int 15:S12

    Article  Google Scholar 

  35. Johnell O, Gullberg B, Allander E, Kanis JA, the MEDOS study group (1992) The apparent incidence of hip fracture in Europe: a study of national register sources. Osteoporos Int 2:298–302

    CAS  PubMed  Google Scholar 

  36. O’Neill TW, Felsenberg D, Varlow J, Cooper C, Kanis JA, Silman AJ 1996 The prevalence of vertebral deformity in European men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res 11:1010–1017

    Google Scholar 

  37. Lindsay RL, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E (2001) Risk for new vertebral fracture in the year following a fracture. JAMA 285:320–323

    Article  CAS  PubMed  Google Scholar 

  38. Kanis JA, Johnell O, Oden A, Borgstrom F, Zethraeus N, De Laet C, Jonsson B (2004) The risk and burden of vertebral fractures in Sweden. Osteoporos Int 15:20–26

    Article  CAS  PubMed  Google Scholar 

  39. Finnern HW, Sykes DP (2003) The hospital cost of vertebral fractures in the EU: estimates using natural data sets. Osteoporos Int 14:429–436

    Article  PubMed  Google Scholar 

  40. Gullberg B, Johnell O, Kanis JA (1997) World wide projections for hip fracture. Osteoporosis Int 7:407–413

    Google Scholar 

  41. Kayan K, De Takats D, Ashford R, Kanis JA, McCloskey EV (2003) Performance of clinical referral criteria for bone densitometry in patients under 65 years of age assessed by spine bone mineral density. Postgrad Med J 79:581–584

    Article  Google Scholar 

  42. Cummings SR, Palermo L, Browner W, Marcus R, Wallace R, Pearson J, Blackwell T, Eckert S, Black D for the Fracture Intervention Trial Research Group (2000) Monitoring osteoporosis therapy with bone densitometry. Misleading changes and regression to the mean. JAMA 283:1318–1321

    Article  CAS  PubMed  Google Scholar 

  43. Compston J (2004) Action plan for the prevention of osteoporotic fractures in the European Community. Osteoporos Int 15:259–262

    Article  Google Scholar 

  44. De Laet C, Oden A, Johnell O, Jonsson B, Kanis JA (2005) The impact of the use of multiple risk factors on case finding strategies: a mathematical framework. Osteoporos Int DOI 10.1007/s00198-004-1689-z

    Google Scholar 

Download references

Acknowledgements

The work was supported by a grant from the International Osteoporosis Foundation. Information on DXA units was kindly provided by K. Faulkner, GE-Lunar.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to J. A. Kanis.

Additional information

The authors represent the Committee of Scientific Advisors of the International Osteoporosis Foundation.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kanis, J.A., Johnell, O. Requirements for DXA for the management of osteoporosis in Europe. Osteoporos Int 16, 229–238 (2005). https://doi.org/10.1007/s00198-004-1811-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-004-1811-2

Keywords

Navigation