Osteoporosis poses a significant public health threat. It is
estimated that approximately 55% of Americans >50 years of age
are affected by this disease.
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
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.
The financial and human costs of such fractures are significant.
The estimated direct cost for osteoporotic fractures in 2001 was
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
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:
- Eat a balanced diet rich in calcium
- Get adequate weight-bearing exercise;
- Do not smoke or consume excessive amounts of alcohol;
- Undergo bone mineral density (BMD) testing and use medication
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.
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.
CompuMed seeks to link bone densitometry with
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
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;
- Body Composition Measurements: designed to provide references
from standard spine and femur scans as well as abdominal-to-hip
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
"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
New "Welcome to Medicare Physical Exam" includes BMD
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.
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.