Application of a triage approach to peripheral bone densitometry reduces the requirement for central DXA but is not cost effective
Application of a triage approach to peripheral bone densitometry reduces the requirement for central DXA but is not cost effective
复制标题
DOI：
10.1007/s00223-005-0302-6
复制
发表时间：
2006-10-01
影响因子：
4.2
通讯作者：
Adams, Judith E.
中科院分区：
文献类型：
--
作者：
Harrison, Elizabeth J.;Adams, Judith E.
一种用于解释外周双能X线吸收测定法（pDXA）测量结果的方法是一种将患者分为三个风险类别之一的分诊方法;（i）高治疗，（ii）中度转诊中央DXA和（iii）低再保险。本研究的目的是将分诊方法应用于外周扫描仪和风险指数的测量，并将患者分为三个风险类别（i），（ii）或（iii）。207名绝经后妇女进行了中心DXA，将其分类为非退行性变或退行性变。在三台扫描仪（GE Lunar Achilles和PIXI，McCue CubaClinical）上对左跟骨进行额外的外周扫描。从人口统计学的细节，四个风险指数计算和算法相结合的措施，从外围扫描仪和一个风险指数。所有外周测量、风险指数和组合算法都能很好地识别骨质疏松症风险的女性（ROC面积：0.67-0.82）。每个工具分层不同数量的乳腺癌和非乳腺癌妇女到每个风险类别使用分流的方法。一种组合算法（PIXI和骨质疏松风险指数（OSIRIS））通过最大限度地减少错误分类（10%非骨质疏松，10%骨质疏松）并将对中心DXA的要求降低至36%而表现最佳。然而，PIXI和OSIRIS实施分类方法的成本（263%）高于中央DXA（100%）扫描所有女性。虽然分类方法是一种有效的工具，在确定妇女的骨质疏松症的风险，不必要的治疗非骨质疏松症的妇女在高风险类别使其不切实际。因此，提出了一种更具成本效益的替代方法。
A method proffered for the interpretation of measurements from peripheral dual energy X-ray absorptiometry (pDXA) is a triage approach to stratify patients into one of three risk categories; (i) high-treat, (ii) medium-refer for central DXA and (iii) low-reassure. The aim of this study was to apply the triage approach to measures from peripheral scanners and risk indices and stratify patients into one of three risk categories (i), (ii) or (iii). 207 post-menopausal women had central DXA from which they were categorised as non-osteoporotic or osteoporotic. Additional peripheral scans of the left calcaneus were performed on three scanners (GE Lunar Achilles and PIXI, McCue CubaClinical). From demographic details four risk indices were calculated and algorithms combining measures from peripheral scanners and one risk index were obtained. All peripheral measures, risk indices and combination algorithms were good at identifying women at risk of osteoporosis (ROC areas: 0.67-0.82). Each tool stratified varying numbers of osteoporotic and non-osteoporotic women into each risk category using the triage approach. One combination algorithm (PIXI & osteoporosis indices of risk (OSIRIS)) performed best by minimising misclassification (10% non-osteoporotic, 10% osteoporotic) and reducing requirement for central DXA to 36%. However the cost of implementing the triage approach for PIXI & OSIRIS was greater (263%) than central DXA (100%) scanning all women. Although the triage approach was an effective tool at identifying women at risk of osteoporosis the unnecessary treatment of non-osteoporotic women in the high risk category make it impractical. Therefore an alternative more cost-effective method has been suggested.