Comparison of Different Indications for Bone Densitometry in Male Patients

Abstract

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.

Keywords

osteoporosis / male / diagnostic threshold / fracture risk assessment / densitometry / dual energy x-ray densitometry / DXA / FRAX / International Society for Clinical Densitometry / ISCD

References

[1] Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int. 1994;4(6):368–381. doi: 10.1007/BF01622200

[2] Lesnyak OM, Baranova IA, Belova KYu, et al. Osteoporosis in Russian Federation: epidemiology, socio-medical and economical aspects (review). Traumatology and orthopedics of Russia. 2018;24(1):155–168. doi: 10.21823/2311-2905-2018-24-1-155-168

[3] Andreeva AT, Baranova IA, Belaya ZhE, et al. Osteoporosis. 2nd edition. Moscow: GEOTAR-Media, 2023. 752 p. EDN NTJNKM

[4] Gladkova EN, Khodyrev VN, Lesnyak OM. An epidemiological survey of osteoporotic fractures in older residents from the Middle Urals. Rheumatology Science and Practice. 2014;52(6):643–649. doi: 10.14412/1995-4484-2014-643-649

[5] Kanis JA, Odén A, McCloskey EV, et al. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporosis Int. 2012;23(9):2239–2256. doi: 10.1007/s00198-012-1964-3

[6] Osteoporosis. Clinical recommendations of the Ministry of Health of the Russian Federation. 2021 [Internet]. Available from: https://cr.minzdrav.gov.ru/schema/87_4. Accessed: 12 May 2025. (In Russ.)

[7] Nikitinskaya OA, Toroptsova NV. Assessment of 10-year probability of osteoporotic fractures with the Russian model of frax® in a population-based sample 5 regions of Russia. Medical Council. 2017;(1S):103–107. EDN: XUYBAB doi: 10.21518/2079-701X-2017-0-103-107

[8] Gladkova EN, Tanaev VG, Lesnyak OM, et al. The effectiveness of screening to identify patients with osteoporosis/high risk of fractures in primary health care. Osteoporosis and Bone Diseases. 2022;25(1):14–22. EDN: MODYDH doi: 10.14341/osteo12946

[9] Skripnikova IA, Myagkova MA, Shalnova SA, et al. Epidemiology of risk factors and estimating 10-year probability of osteoporotic fractures in the Russian Federation. Arch Osteoporos. 2022;17(1):62. doi: 10.1007/s11657-022-01093-x

[10] Baranova IA, Suleymanova AK, Zakharova VV. Diagnosis of osteoporosis in COPD patients: Estimation of the 10-year probability of a major osteoporotic fracture (FRAX), and Dual-energy X-Ray Absorptiometry. Pulmonologiya. 2021;31(3):338–347. doi: 10.18093/0869-0189-2021-31-3-338-347

[11] Gladkova EN, Nikitinskaya OA, Skripnikova IA, et al. FRAX-based intervention thresholds for men in the Russian Federation: Expert consensus of the Russian association on osteoporosis. Rheumatology Science and Practice. 2023;61(3):320–329. EDN: FETYHI doi: 10.47360/1995-4484-2023-320-329

[12] Gladkova EN, Lesnyak OM, Ershova OB, et al. Comparison of the effectiveness of different approaches to osteoporosis diagnosis organizing and identification of patients at high fracture risk in the Russian population. Russian Journal of Preventive Medicine. 2021;24(10):14-23. EDN: OZBHYE doi: 10.17116/profmed20212410114

RIGHTS & PERMISSIONS

Eco-Vector