Availability and Reimbursement of Bone Mineral Density Measurement in European Countries: A European Foundation for Osteoporosis Report

  • Published 1997 in Osteoporosis International

Abstract

The currently accepted definition of osteoporosis is ‘a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue with consequent increase in bone fragility and susceptibility to fracture risk’ [1]. The assessment of bone mineral mass is therefore central to early diagnosis and assessment of prognosis in this disease. Despite this and a wealth of data showing that osteoporosis is a detectable and preventable disease, the benefits of bone mineral mass measurement are not as widely available to those at risk as they should be. Skeletal radiographs are well recognized to be a very insensitive and inaccurate method of assessing the amount of bone mineral mass, with 25–40% of bone mass needing to be lost before detection by this method. In addition, radiographs may lead to incorrect diagnoses. Sadly many cases of osteoporosis continue to be diagnosed by standard radiographs alone, confirming that early diagnosis and thus prevention is not occurring in many patients. Currently the most widely accepted method for assessing bone mineral mass is bone mineral density (BMD) measurement using either single-energy (for peripheral sites) or dual-energy (for axial sites) absorptiometry. BMD measurement is well established and validated as a diagnostic, prognostic and monitoring tool in the management of osteoporosis. BMD measurement should be used as a diagnostic tool in all individuals with significant risk factors when a result will influence clinical management (Table 1). BMD also provides important prognostic information – the risk of fracture approximately doubles for each standard deviation decrease in BMD relative to the healthy population. In addition, BMD measurements may be useful for monitoring the natural history of osteoporosis either treated or untreated, in which case it is important that the same instrument is used for follow-up measurements. Other techniques to measure bone quality have been, and are being, developed but use is either limited or the techniques are not yet fully validated. Recent feedback from specialists practising in the field, national osteoporosis societies, and members of the EFFO Scientific Advisory Board confirms that in the majority of European countries BMD measurement is significantly under-utilized in the diagnosis of osteoporosis. This underuse results from a variety of factors, the most important of which appear to be low availability of bone densitometers (e.g. Sweden), restriction in the personnel allowed to perform bone densitometry (e.g. Italy) and non-reimbursement of the procedure (e.g. France). In some situations there also appears to be a lack of knowledge by non-specialists of the usefulness of BMD measurement and appropriate criteria for referral of patients. Osteoporos Int (1997) 7:496–499 ß 1997 European Foundation for Osteoporosis and the National Osteoporosis Foundation Osteoporosis International

DOI: 10.1007/s001980050038

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Cite this paper

@article{1997AvailabilityAR, title={Availability and Reimbursement of Bone Mineral Density Measurement in European Countries: A European Foundation for Osteoporosis Report}, author={}, journal={Osteoporosis International}, year={1997}, volume={7}, pages={496-499} }