In-office Osteoporosis Screening Serves a Growing Need

Low bone density and low bone mass are common conditions affecting millions of Americans, many of whom are unaware they have these serious health problems. To address this underserved population, more and more primary care physicians are offering in-office bone density screenings with DXA and ultrasound scanning equipment to prevent, diagnose, and treat osteoporosis.

According to the National Osteoporosis Foundation, about 44 million Americans, more than half aged 50 and older, have osteoporosis or osteopenia. These conditions are widespread and under diagnosed. If left undetected or untreated, a patient with osteoporosis could experience a serious facture, lessening quality of life, increasing pain and recuperation time, and requiring more expensive treatment.

DXA Scanners
Bone densitometry with DXA (dual-energy x-ray absorptiometry) uses x-ray technology to measure bone loss. This painless procedure uses a small dose of ionizing radiation to make an image of a bony area, such as the pelvis, hip, hand, wrist, or heel.

In-office DXA scanning is quick and non-invasive. A DXA scan takes between 10 and 30 minutes. A scan resulting in a T-score between -1 and -2.5 of baseline indicates osteopenia, and a T-score less than -2.5 of baseline is evidence of osteoporosis, according to the World Health Organization.

Ultrasonometers
Smaller, portable ultrasonometers use ultrasound waves to assess bone health. Numerous clinical studies show that ultrasonometry of the heel is an economical and reliable complement to DXA.  Testing is fast and you get immediate results enabling you to counsel patients and make sound treatment decisions.  Ultrasonometer heel scanners fit in less than two square feet of office space and they are easy to take on the road to satellite offices, nursing homes, or outreach programs. Portability makes the ultrasonometer ideal to use as an early assessment tool for identifying patients for DXA scans.

Who Is at Risk?
While osteoporosis and osteopenia are more prevalent in seniors and women, the conditions can afflict anyone. Bone mass loss begins in people as young as 30. Those most at risk are postmenopausal women, people with past bone fractures, smokers, thin or slender people, sedentary people and those who get little exercise, those who take glucocorticoid medication, and those with diabetes, thyroid condition, liver disease, kidney disease, and lupus.

Physicians should target existing patients that present with these risk factors and suggest they get a painless bone density screening. In-office screening is convenient and can be performed at the time of wellness exams, physicals, or scheduled office visits. Patients don’t need to make an additional appointment, which is beneficial for elderly clientele who may have difficulty traveling.

In addition to existing patients, physicians can advertise this valuable service to the community or targeted groups, such as seniors, to bring in new patients who may not be aware of their risk for osteoporosis. Bone density screening complements other ancillary services, such as nutrition counseling, weight management, smoking cessation, and diabetes management for full patient care.

Once a patient is diagnosed with low bone mass or low bone density, the physician should monitor and track the condition, treat it, and suggest periodic follow-up DXA screenings. Surprisingly, many patients who have suffered previous factures were not properly diagnosed with osteoporosis or treated for it.

The High Cost of Fractures
Patients who are not screened or their condition is not caught early and treated may experience a fracture. Hip fractures commonly affect the elderly, many of whom require expensive long-term care. Osteoporosis-related fractures cost the U.S. roughly $19 billion in 2005, according to the National Osteoporosis Foundation. That figure could rise to $25 billion by 2025. Moreover, almost a quarter of people over age 50 who have fractured a hip die within a year, and vertebral fractures also increase the risk of death.

In addition to causing fractures, osteoporosis affects quality of life issues. The disease is associated with cognitive decline, depression, loss of self-esteem, and reduced social support.

Selecting a Bone Densitometer DXA Scanner
Adding in-office osteoporosis assessment to your patient services can increase revenues for your practice. Consult your financial manager to determine if you can afford the initial investment of a DXA or ultrasound scanner and prepare a business plan to see if screenings will be cost effective.

If you decide to offer bone density tests in-house, research which type of machine is appropriate for your practice. Larger DXA machines generally examine the lower spine and hips. Smaller ultrasound machines can screen hands and feet. These smaller units weigh about 60 pounds, are portable, and are suitable for smaller offices, clinics, and mobile health vans.

Before purchasing a bone densitometer, research its accuracy, ease of use, price, software, and the vendor’s training program, technical support, and customer service. The three major companies manufacturing bone densitometry equipment are GE Healthcare, which sells the Duo and Prodigy series bone densitometers and the Achilles series of ultrasonometers; Hologic’s series of machines; and Norland’s Excell, Eclipse, and Apollo models. Other companies selling scanners are Schick Technologies, DMS, and Osteometer Meditech.