Women have choices, too many perhaps, when it comes to osteoporosis screening. A Maryland supermarket is running radio advertisements for on-the-spot bone mass density (BMD) screening. Supermarkets, drug stores, and department stores throughout the land have hung out their shingles and gone into the osteoporosis screening business. When a disease poses as significant a public health threat as does osteoporosis, improving access is important. Access, however, is not all.
For a review of the screening and monitoring options, see “Pondering the Osteoporosis Puzzle” by Gary L. Hoff, DO, which touches on the technology options and risk factors, as well as the controversy surrounding T-scores. T-score discrepancies among screening devices, skeletal sites measured, and population groups are significant enough to have attracted the attention of the Food and Drug Administration. Do not let the technology issues overshadow a more important truth–in detecting, treating, and preventing osteoporosis, the judgement of an educated and informed medical professional is required.
While the issues are debated and screening protocols devised, the National Osteoporosis Foundation estimates that the disease will result in 1.5 million fractures this year. Direct costs of hospital and nursing home treatment for patients with fractures due to osteoporosis is estimated by the NOF to be $38 million per day and rising.
In approving Medicare reimbursement for osteoporosis, the Health Care Finance Administration recognized the importance of screening. But the only way to accrue the full benefits of a screening program is to screen a population in which disease is preventable as well as treatable. For women with high risk, waiting until the age of 65 is not ideal.
Some managed care organizations have demonstrated reluctance to reimburse for BMD screening. One reason for this reluctance is a widespread misconception that BMD screening is required annually or semi-annually, believes David Sartoris, MD, director of quantitative bone density analysis at the John M. and Sally B. Thornton Hospital, La Jolla, Calif, and professor of radiology at University of California, San Diego. The reality is that most people in the United States will require one or two tests at the most, explains Sartoris, who is also a support group coordinator for the National Osteoporosis Foundation.
One test is needed to determine whether or not disease is present; and two only if it is present 1 or 2 years after treatment begins to monitor response. The only reason anyone should have more than two is if there are changes in treatment, and many people in low risk categories will require none. At $68 per skeletal site measured, with two sites recommended per screening, the average lifetime cost of detecting osteoporosis and monitoring treatment for one person is less than $300.
Active on the local and national level in the campaign to prevent osteoporosis, Sartoris has written an excellent article for consumers on osteoporosis and the characteristics of a clinically useful BMD measurement, which has been published in the San Diego Union among other local papers. (He can be contacted at (619) 657-6672; [email protected].)
So who will adopt the campaign to prevent osteoporosis by promoting the clinically useful testing of at-risk patients? Will it be the rheumatologists and endocrinologists who have conducted much of the research? The orthopedists, whose ambulatory surgery centers are proliferating throughout the country? Will it be the radiologists with their established networks of referring physicians? Or will it be the retailers of America?
