Pi Phi Chapter

Pointing the Finger at Bone Density Screening: Device Reliability for Central Bone Density Testing Referrals

Nursing Research on the Green

2013 Abstract

Ann C. Falkenberg Olson, PhD, CNP, CCD, FAANP; Winona State University-Rochester

  • Background:  Incidence and Economic Impact A problem in estimating osteoporosis impact is that many people do not know their risk or if they have low bone density (BMD). Although pharmacologic therapy can reduce fracture risk, osteoporosis is often undiagnosed until fracture occurs. Adverse consequences affect health care costs; by 2025 three million fractures are predicted costing $25.3 billion unless effective preventive and intervention measures are enacted. *BMD Testing BMD technology is used to monitor osteoporosis and in studies with BMD as a surrogate marker. Hip/spine dual energy X-ray absorptiometry (DXA) is the most reliable tool for BMD testing but access to central DXA is limited to onsite testing in health care organizations. Lack of scientific evidence precludes recommending BMD testing of women before menopause and of most men. An important omission from literature is effective screening techniques and identification of patients with low BMD who may benefit from early intervention. *ACCUDXA2 The ACCUDXA2 device is an updated accuDEXA model and is a self-contained table-top DXA densitometer measuring BMD of the non-dominant hand middle finger intermediate phalange. After finger scan, T-scores are produced in < 60 seconds. Original accuDEXA demonstrated good predictability of osteoporosis and hip low BMD. Updated ACCUDXA2 was recently FDA-approved for testing; improvements include "changing finger positioning so that optimal region of interest is imaged on the sensor" (J. Singer, personal communication, July 10, 2012). This improvement "identifies, stabilizes, and tests only the intermediate phalange, theoretically demonstrating higher correlation with hip DXA T-scores" (A. Keim & J. Singer, personal communication, July 10, 2012). Comparative studies of updated ACCUDXA2 to central site DXA are recommended.
  • Significance:  Current clinical guidelines support baseline bone density testing only in postmenopausal women and in select groups among men; therefore, many adults and their providers are unaware of individualized osteoporosis risk. Early screening and detection of low bone density will promote development and testing of nursing interventions focusing on at-risk adults and will bolster effective osteoporosis preventive behaviors.
  • Purpose/objective:  To determine how phalange BMD screening results of peripheral ACCUDXA2 device compare to central hip, femur neck, lumbar spine and peripheral femur BMD testing results of the Hologic Fan Beam.  To provide feedback for device manufacturer.
  • Methods/project:  IRB approvals were obtained. Via convenience sampling, 200 community-dwelling adults presenting for clinical BMD testing and meeting criteria were screened (ACCUDXA2 phalange) and tested (DXA total hip, femur neck, lumbar spine, forearm). Supporting study fidelity, only 1 DXA and 1 ACCUDXA2 densitometers were used; 2 DXA technicians (ISCD precision testing criteria met) and 1 certified clinical densitometrist (CCD) performed all procedures with 15% of BMD results reviewed by another CCD. Data were entered into Microsoft Excel and analyzed via SPSS and SAS and compared. ACCUDXA2 results were compared to each DXA anatomic site result for predictability and reliability.
  • Results:  (Ongoing; results to date.)
  • Clinical implications:  Early detection of low BMD is important in clinical practice for patients, health care professionals, and societal health. Developing, testing, and applying effective and reliable BMD screening devices will support appropriate referral for central DXA testing to detect those at highest risk for osteoporosis and subsequent fracture. A longitudinal study using multi-clinical sites and various population samples is considered.

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