Background: Recently, the dual-energy X-ray absorptiometry (DXA) diagnostic cut-off (T-score) for Australian Pharmaceutical Benefits Scheme (PBS) supported primary fracture prevention therapy with alendronate for older women (>70 years) has been changed from -3.0 to -2.5. Aim: To examine the impact of the expanded criteria for PBS-supported fracture prevention therapy in older women on case finding and cost. Methods: One thousand, nine hundred and eighty-three women, median age 76 years, not previously known to have low bone mineral density by DXA or a vertebral fracture underwent DXA scanning and a thoracolumbar X-ray. A woman was considered eligible for fracture prevention therapy if she had a T-score -2.5 at the femoral neck and/or the lumbar vertebrae (two to four) or at least one vertebral fracture of 20 deformity. Results: Seven hundred and forty-six women (37.6 ) met the new criteria as a case for PBS-subsidised fracture prevention therapy. Four hundred and thirty-one (21.7 ) had a T-score -2.5 on DXA compared with 10.6 (n = 210) with a T-score -3.0. Four hundred and eighty-three (24.4 ) had at least one vertebral fracture. Only 8.5 (n = 168) had both a T-score -2.5 and a prevalent vertebral fracture. The cost per case found by DXA equated to 460 compared with 398 for screening by thoracolumbar X-ray. Conclusions: The use of either DXA or X-ray will identify approximately two-thirds of women aged 70 years and over who would be eligible for fracture prevention. The use of X-ray would identify a marginally larger number of women and at lower financial cost but involve substantially greater radiation exposure.
Robinson, P. J., Bell, R. J., Lanzafame, A., Segal, L., Kirby, C. N., Piterman, L., & Davis, S. R. (2013). Comparison of plain vertebral x-ray and dunal energy x-ray absorptiometry for the identification of older women for fracture prevention in primary care. Internal Medicine Journal, 43(1), 38 - 45. https://doi.org/10.1111/j.1445-5994.2012.02930.x