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See detailDual energy X-ray absorptiometry-based assessment of male patients using standardized bone density values and a national reference database
Goemaere, S.; Vanderschueren, D.; Kaufman, J. M. et al

in Journal of Clinical Densitometry (2007), 10(1, JAN-MAR), 25-33

Dual energy X-ray absorptiometry (DXA) measurements from different manufacturers provide different bone mineral density (BMD) values and derived T-scores and Z-scores. These differences result partly from ... [more ▼]

Dual energy X-ray absorptiometry (DXA) measurements from different manufacturers provide different bone mineral density (BMD) values and derived T-scores and Z-scores. These differences result partly from technical differences in the algorithms for the determination of bone mineral content and bone area and partly from the use of different manufacturer-derived reference databases. The present study was to implement a uniforrn expression of BNID in all male patients by using standardized BMD (sBMD) values and referring to a newly established national male reference sample. In 8 bone densitometry centers throughout Belgium 229 young healthy men were measured on Hologic (Bedford, MA) or GE-Lunar (Madison, WI) bone densitometers. Quality control procedures were implemented and site cross-calibration performed using the European Spine Phantom. Absolute BMD values were converted to standardized values by validated formulas (sBMD). Clinically acceptable between-center differences were noted. No discrepancy was observed in terms of mean sBMD and standard deviations at the lumbar spine and proximal femur between the Belgian and the US reference populations. Region-specific sBMD thresholds for the diagnosis of male osteoporosis were calculated. The current data provide a basis to implement a nation-wide, uniform expression of BMD in male patients and allow harmonization of the BMD-based diagnosis and treatment of osteoporosis in men. [less ▲]

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See detailDXA-based assessment of male patients using standardized bone density values and a national reference database
Goemaere, S.; Vanderschueren, D.; Kaufman, Jean-Marc et al

in Osteoporosis International (2006, March), 17(Suppl.1), 54

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See detailInterest of a prescreening questionnaire to reduce the cost of bone densitometry
Ben Sedrine, Wafa ULg; Broers, P.; Devogelaer, J. P. et al

in Osteoporosis International (2002), 13(5), 434-442

Bone mineral density (BMD) measurement is widely recognized as the best single tool to identify patients with a high lifetime risk of developing an osteoporosis-related fracture. However, the cost/benefit ... [more ▼]

Bone mineral density (BMD) measurement is widely recognized as the best single tool to identify patients with a high lifetime risk of developing an osteoporosis-related fracture. However, the cost/benefit value of screening the whole population has been repeatedly challenged and demonstrated to be rather poor. In many countries, BMD scan is not or no longer reimbursed because of lack of validated criteria to identify patients who should benefit from this procedure. Based on the proposals of a nationwide expert panel, a simple questionnaire identifying historical, clinical and behavioral risk factors for osteoporosis was developed. The aim of this study was to assess the diagnostic accuracy of the proposed criteria; to determine the extent to which this questionnaire could be useful for optimizing the use of densitometry tests; and, more specifically, to estimate the diagnostic costs per osteoporotic or osteopenic patient detected. For this purpose, we applied the questionnaire to 3998 consecutive individuals at least 20 years old, of both genders, either consulting spontaneously or referred for a BMD measurement to an outpatient osteoporosis center. BMD was measured by dual-energy X-ray absorptiometry (DXA) at the lumbar spine and at the hip (both total hip and femoral neck). Diagnostic accuracies were evaluated through measures of sensitivity, specificity, and positive and negative predictive values. After determining a benchmark value for age, different strategies were compared in order to identify the most cost-effective one in terms of cost per patient detected. According to the WHO operational definition of osteoporosis (T-score <-2.5), 31% of the subjects were classified as osteoporotic at one or more of the measured sites. If only patients with at least one of the proposed risk factors had been referred for scans, 33.3% of the BMD measurements would have been avoided. Among those, less than 5% were missclassified as they did have osteoporosis at the total hip and up to 23% at one or more of the considered sites. On the other hand, of the subjects who would be recommended for a densitometry test, only a small fraction were identified correctly (the positive predictive values varied from 11.3% at the total hip to 34.8% at any site). In this first setting, the suggested criteria seem useful chiefly for excluding subjects who do not need a DXA scan rather than selecting osteoporotic patients. When applied only to patients aged 61 years or more, the positive predictive values rose to 15.1% (total hip) and 42.9% (any site), whereas the corresponding negative predictive values were set at 93% and 68.6%. In comparison, with a mass screening scenario the estimated diagnostic costs (costs associated with the DXA procedure) per osteoporotic patient detected at any of the considered sites would be reduced by more than 9% (59.4 instead of 65.3 Euros) if the suggested indications are taken into account for prescreening patients. And when the questionnaire is applied only to women over the age of 60 years these costs would be further reduced to 50.6 Euros, representing a 23% decrease. Then, a prescreening strategy based on these indications concomitantly with an age-selective criterion could represent a promising way toward a more rational use of BMD measurement. [less ▲]

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See detailEvaluation of the Simple Calculated Osteoporosis Risk Estimation (Score) in a Sample of White Women from Belgium
Ben Sedrine, Wafa ULg; Devogelaer, J. P.; Kaufman, J. M. et al

in BONE (2001), 29(4), 374-80

Identifying patients at risk of developing an osteoporosis-related fracture will continue to be a challenge. The "gold standard" for osteoporosis diagnosis is bone densitometry. However, economic issues ... [more ▼]

Identifying patients at risk of developing an osteoporosis-related fracture will continue to be a challenge. The "gold standard" for osteoporosis diagnosis is bone densitometry. However, economic issues or availability of the technology may prevent its use under a mass screening scenario. A risk assessment instrument, the "simple calculated osteoporosis risk estimation" (SCORE), has been reported to appropriately identify women likely to have low (t score < or = -2 SD) bone mineral density (BMD) and who should be referred for bone densitometry. The aim of our study is to evaluate the discriminatory performance of SCORE in a random sample of postmenopausal white women from Belgium. For this purpose, we gathered medical data on 4035 consecutive patients aged > or = 45 years, either consulting spontaneously or referred for a BMD measurement to an outpatient osteoporosis center located at the University of Liege, Belgium. BMD measurements, using dual-energy X-ray absorptiometry (DXA) technology, were taken at the hip (total and neck) and lumbar spine (L2-4). At the recommended cutoff point of 6, SCORE had a sensitivity of 91.5% to detect low BMD at any of the measured sites, a specificity of 26.5%, a positive predictive value of 52.8%, and a negative predictive value of 77.7%. According to SCORE, 18% of the patients would not be recommended for densitometry. Among these, 10.9% were misclassified as they had osteoporosis (t score < or = -2.5 SD) at one or more of the sites investigated. The negative predictive errors of SCORE, when failing to detect osteoporosis, were only 1% for the total hip, 3.2% for the femoral neck, and 8.8% for the lumbar spine. We conclude that, notwithstanding the high values of sensitivity, SCORE specificity is too low to be useful as a diagnostic tool for screening patients at high risk to later develop osteoporosis. Nevertheless, from a resource allocation perspective, this instrument can be used with relative confidence to exclude patients who do not need a BMD measurement, and would therefore provide an opportunity to realize substantial cost savings in comparison to a mass screening strategy. [less ▲]

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See detailInterest of a prescreening questionnaire to reduce the cost of bone densitometry
Ben Sedrine, Wafa ULg; Broers, P; Devogelaer, JP et al

in Clinical Rheumatology (2001), 20

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See detailEvaluation of the simple calculated osteoporosis risk estimation in a sample of Caucasian women from Belgium
Ben Sedrine, Wafa ULg; Devogelaer, JP; Kaufman, JM et al

in Clinical Rheumatology (2001), 20

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See detailInterest of the simple calculated osteoporosis risk estimation (SCORE) tool for a more rational use of bone densitometry
Ben Sedrine, Wafa ULg; Devogelaer, JP; Kaufman, JM et al

in Value in Health (2000, March), 3

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See detailThe simple calculated osteoporosis risk estimation (SCORE) does not allow identification of Belgian women with a high risk of osteoporosis
Ben Sedrine, Wafa ULg; Devogelaer, Jean-Pierre; Kaufman, Jean-Marc et al

in Value in Health (2000, March), 3

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See detailInterest of the simple calculated osteoporosis risk estimation (SCORE) tool for a more rational use of bone densitometry
Ben Sedrine, Wafa ULg; Devogelaer, JP; Kaufman, JM et al

in Osteoporosis International (2000), SS(S5), 13

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See detailInterest of a simple pre-screening test for optimizing the cost/benefit value of bone densitometry
Ben Sedrine, Wafa ULg; Broers, Ph; Brands, G et al

in Osteoporosis International (2000), SS(S5), 13

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See detailThe simple calculated ostoporosis risk estimation (SCORE) does not allow to identify Belgian women with a high risk of osteoporosis
Ben Sedrine, Wafa ULg; Devogelaer, JP; Kaufman, JM et al

in Osteoporosis International (2000), 11(S2), 3

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See detailThe simple calculated osteoporosis risk estimation (SCORE) does not allow identification of Belgian women with a high risk of osteoporosis
Ben Sedrine, Wafa ULg; Devogelaer, Jean-Pierre; Kaufman, Jean-Marc et al

in Annals of the Rheumatic Diseases (2000), 59(Suppl.1), 80

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See detailInterest of the simple calculated osteoporosis risk estimation (SCORE) tool for a more rational use of bone densitometry
Ben Sedrine, Wafa ULg; Devogelaer, Jean-Pierre; Kaufman, Jean-Marc et al

in Annals of the Rheumatic Diseases (2000), 59(Suppl.1), 80-81

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See detailInterest of a simple pre-screening test for optimazing the cost/benefit value of bone densitometry
Ben Sedrine, Wafa ULg; Broers, P; Brands, G et al

in Arthritis and Rheumatism (1999), 42(S1), 289

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