Report: Many EU countries lack adequate DEXA scanning facilities

The investigators found an additional 6.39 DEXA units/million were needed to adequately diagnose osteoporosis in EU member states.

Issue: Issue 3 2005

An inadequate number of dual energy X-ray absorptiometry scanners exist in Europe for them to be used most effectively and aid in the timely diagnosis and treatment of osteoporosis, according to a recent report.

In response to these findings, members of the European Parliament (EP) Osteoporosis Interest Group urged European Union policy makers to address this problem and pledge their commitment to better osteoporosis diagnosis and treatment.

John A. Kanis, of the World Health Organization Collaborating Centre for Metabolic Bone Diseases, in Sheffield, England, and Olof Johnell, MD, vice chairman of the International Osteoporosis Foundation (IOF) Committee of Scientific Advisors, from Malmo, Sweden, wrote the revealing report, “Requirements for DXA for the management of osteoporosis in Europe.”

Their position paper was published in March in Osteoporosis International.

In the report, Kanis and Johnell highlighted the fact that the availability of dual-energy X-ray absorptiometry (DEXA) scanners was less than that needed in many EU member states, based on fracture data they studied from several of the countries, IOF officials said in a press release.

They concluded that, even with effective screening, “both DEXA availability and usage was suboptimal in many countries. According to the report, the burden of osteoporosis would continue to grow dramatically unless decisive action is taken now at national and European levels,” according to the release.

To tackle the problem, the EP interest group that reviewed the report strongly urged authorities in EU member states to act in accordance with the 1998 recommendations of the European Commission and ensure that osteoporosis care stays in the forefront of health strategies being considered by their governments.

An abstract of the study published in the IOF release noted that one of the chief problems in assessing DEXA technology is that there is little information available that clearly identifies the optimal requirements for implementing this technology.

For the study, the authors explored three scenarios for assessing and treating osteoporosis in EU citizens: 1) using DEXA to screen all women for osteoporosis when they reach 65 years old; 2) screening them after identifying clinical risk factors, and then selectively using bone mineral density (BMD) testing in those who are identified as needing intervention soon; and 3) approaching the problem on a case-wise basis, where women are identified according to their clinical risk factors. Physicians would then separate the 65-year-olds and others with high-risk factors from that group for DEXA studies.

“Requirements for women aged more than 65 years were amortized over a 10-year period. A secondary aim was to estimate the number and cost of osteoporotic fractures in Europe,” the investigators wrote in the abstract.

The researchers determined that using DEXA for adequate assessment required 4.21 to 11.21 units/million of the population. They also found the second scenario — identification of clinical risk factors with selective BMD testing — was best for assessing osteoporosis.

“With this scenario, an additional 6.39 units/million would be required to monitor treatment, giving a total requirement of 10.6 units/million,” according to the abstract.

For more information:
Kanis JA, Johnell O. Requirements for DXA for the management of osteoporosis in Europe. Osteoporosis International. 2005;16,3:229-238.