Comparison of the effectiveness of different approaches to determine the indications for densitometry in men

Purpose of the study:

To evaluate the effectiveness of the use of current and alternative intervention thresholds based on the assessment of the 10-year probability of fractures (FRAX), as well as using the recommendations formulated by the International Society of Clinical Densitometry ISCD to refer men aged 50 years and older to densitometry.

Material and methods:

We conducted a simultaneous study of a random sample of men aged 50 and over, sent for DXA densitometry at St. Petersburg State Public Health Institution "Clinical Rheumatological Hospital named after V.A. Nasonova" without pre-selection with data on risk factors used in the calculation of the 10-year probability of fractures (FRAX).

4 approaches to identifying patients with a high risk of fractures were analyzed: referring patients to densitometry based on ISCD 2023 recommendations and identifying patients with a high risk of fractures based on calculating the 10-year risk of fractures using the FRAX algorithm: age-dependent "female", age-dependent "male" and fixed "male" thresholds of diagnostic intervention. The indicators of the diagnostic value of the methods were evaluated: sensitivity, specificity and accuracy of the test, as well as the costs of diagnosing one case of high risk of fractures.

Results:

The use of a strategy for finding patients with a high risk of fractures based on ISCD recommendations led to an unreasonably high number of densitometric studies and an increase in diagnostic costs. The existing ("female") threshold of diagnostic intervention was associated with the lowest coverage of patients by densitometry (14.4%) and revealed the lowest proportion of men with a high risk of fractures (7.7%). Optimal densitometry coverage (47.5%) with sufficient identification of patients with a high risk of fractures (25,3%) was noted when using a fixed "male" threshold of diagnostic intervention.