Osteoporosis poses a significant public health threat. It is estimated that approximately 55% of Americans >50 years of age are affected by this disease. ¹ According to the National Osteoporosis Foundation (NOF), 8 million women and 2 million men already have osteoporosis and an additional 34 million Americans are at risk of developing it due to low bone mass. ¹ Furthermore, the organization notes that osteoporosis is responsible for >1.5 million fractures a year, including 300,000 hip fractures and 700,000 vertebral factures. ¹

The financial and human costs of such fractures are significant. The estimated direct cost for osteoporotic fractures in 2001 was $17 billion. ¹ In terms of morbidity, 24% of those aged ≥50 years who experience a hip fracture die within the following year; among those who were ambulatory prior to a hip fracture, nearly 1 in 4 will require long-term care. ¹

Because the majority of bone development happens before age 20, the best defense against osteoporosis is to have a healthy childhood with appropriate nutrition and adequate exercise. But that does not mean that adults have no means by which to ensure optimal bone health. The NOF recommends that all adults follow four steps to help reduce the risk of developing osteoporosis:

1. Eat a balanced diet rich in calcium
2. Get adequate weight-bearing exercise;
3. Do not smoke or consume excessive amounts of alcohol; and
4. Undergo bone mineral density (BMD) testing and use medication when indicated. ²

According to the NOF guidelines, BMD testing should be performed on all women >65 years of age, regardless of risk factors, as well as on younger postmenopausal women with risk factors (Table) and on all postmenopausal women who present with fractures. ² The study and the physician's interpretation of BMD testing are reimbursable under Medicare for estrogen-deficient women at risk for osteoporosis, as well as people with vertebral abnormalities, those receiving long-term glucocorticoid steroid therapy, those with primary hyperparathyroidism, and patients being monitored for response to osteoporosis drug therapy. ³

CompuMed seeks to link bone densitometry with mammography

Despite published guidelines and available reimbursements, many women are not tested for bone loss. "The public health problem itself is that far too few women get tested," said Jerry McLaughlin, CEO of CompuMed, Inc. (Los Angeles, CA), "but they do get a mammogram every year. So combining the screening for osteoporosis on the same equipment at the same time as the screening for breast cancer is a big win for women."

CompuMed recently filed for patent protection for the integration and use of its OsteoGram osteoporosis screening/diagnostic system on digital mammography equipment. The OsteoGram, a software-based solution, uses digital images of the hand acquired on either digital or conventional X-ray systems to assess bone density (Figure 1). With the proposed integration, the OsteoGram will use images acquired with digital mammography equipment to perform osteoporosis testing during routine mammograms.

McLaughlin noted that CompuMed has partnered with several companies in an effort to link the OsteoGram software with a variety of digital mammography systems. "One company, FujiFilm Medical Systems (Stamford, CT), showed the OsteoGram in conjunction with their computed radiography mammography platform at the 2004 Radiological Society of North America meeting," he said.

McLaughlin said that the OsteoGram was well suited to serve as a screening tool because of the speed with which the study can be performed. "An imaging center can screen a lot of people on our system because it's fast," he said. "It's a simple hand X-ray versus a total body scan. The screening can be done on our system and then, if they want to, an imaging center can take those patients with positive findings and confirm the diagnosis on their dual energy X-ray absorptiometry (DXA) system."

GE adds features to bone densitometer

GE Healthcare (Waukesha, WI) recently added features to its Lunar Prodigy Advance bone densitometer, including the ability to provide reproducible body fat measurements during osteoporosis testing. The new enCore software includes:

• Femur Strength Index: designed to allow the clinician to measure femur structure as well as BMD;
• 10-year Personalized Fracture Risk Calculator: designed to predict a patient's risk of fracture in the next 10 years; and
• Body Composition Measurements: designed to provide references from standard spine and femur scans as well as abdominal-to-hip fat ratios.

The software uses the company's SmartFAN technology to actively track the bone and adjust the scan during acquisition to help reduce the chance of operator error. The AutoAnalysis feature calculates the results with one keystroke and the reports include patient information, scan image, and fracture risk assessment based on established criteria from the World Health Organization. It also provides trending tables and graphs to help monitor changes over time.

"In a single 5-minute examination, a clinician can access critical information that will allow them to detect issues earlier, diagnose them more precisely, and make better treatment decisions," said Jennie Hansen, president of Primary Care Diagnostics at GE Healthcare.

New "Welcome to Medicare Physical Exam" includes BMD information

Effective January 1, 2005, Medicare will now pay for a one-time "Welcome to Medicare Physical Exam" for all new beneficiaries within the first 6 months of their enrollment. ⁴

The examination includes a review of the patient's medical and social history; depression screening; functional ability assessment; documentation of height, weight, blood pressure, visual acuity; performance and interpretation of an electrocardiographic study; and other assessments deemed necessary by the physician.

Of importance to the radiologist is the requirement that the physician provide education, counseling, and referral for other appropriate screening and preventive services covered by Medicare, including BMD testing.