Comparison of Different Indications for Bone Densitometry in Male Patients

BACKGROUND: The national clinical guidelines include referral criteria for bone densitometry in cases of osteoporosis. These criteria are based on the 10-year risk of major fragility fractures, as calculated by the Fracture Risk Assessment Tool (FRAX). The effectiveness of the current diagnostic threshold for male patients has not yet been evaluated in Russia.

AIM: The study aimed to evaluate the current and alternative thresholds for assessing 10-year fracture risk using the FRAX tool and the International Society of Clinical Densitometry (ISCD) guidelines for bone densitometry referrals in male patients aged 50 years and older.

METHODS: A cross-sectional study was conducted in a random population of male patients aged 50 years and older who were referred for dual-energy X-ray absorptiometry. Diagnostic criteria such as sensitivity, specificity, and accuracy of various approaches to identifying patients at high risk for fractures were evaluated. These criteria are based on ISCD guidelines, with diagnostic thresholds based on 10-year fracture risk (FRAX) charts. The cost of diagnosing each case of high fracture risk was also estimated.

RESULTS: Implementation of the ISCD guidelines increased diagnostic costs due to the large number of unnecessary densitometries performed. The current diagnostic threshold developed for female patients was associated with the lowest patient coverage by densitometry (14.4%) and identified the smallest percentage of men at high risk for fractures (7.7%). The use of male diagnostic thresholds provided optimal densitometry coverage and sufficient identification of patients at high risk for fractures at minimal cost.

CONCLUSION: The alternative diagnostic thresholds for identifying men at high fracture risk proposed in the study were more effective and less costly than the current approach according to ISCD guidelines.