Journal of Clinical Densitometry
Volume 9, Issue 4 , Pages 413-418 , October 2006

What is the Number of Older Canadians Needed to Screen by Measurement of Bone Density to Detect an Undiagnosed Case of Osteoporosis? A Population-Based Study From CaMos

  • Anna M. Sawka

      Affiliations

    • Department of Medicine, Division of Endocrinology, University of Toronto, Toronto, Ontario
    • Department of Medicine, Division of Endocrinology, University Health Network, Toronto, Ontario
    • Corresponding Author InformationAddress correspondence to: Anna M. Sawka, Toronto General Hospital, 200 Elizabeth Street, Eaton North 12-212, Toronto, Ontario M5G 2C4, Canada.
    • ,
  • Alexandra Papaioannou

      Affiliations

    • Department of Medicine, McMaster University, Hamilton, Ontario
    • Department of Medicine, Hamilton Health Sciences, Hamilton, Ontario
    • ,
  • Robert G. Josse

      Affiliations

    • Department of Medicine, Division of Endocrinology, University of Toronto, Toronto, Ontario
    • Division of Endocrinology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario
    • ,
  • Timothy M. Murray

      Affiliations

    • Department of Medicine, Division of Endocrinology, University of Toronto, Toronto, Ontario
    • Division of Endocrinology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario
    • ,
  • George Ioannidis

      Affiliations

    • Department of Medicine, Division of Rheumatology, St. Joseph's Healthcare, Hamilton, Ontario
    • ,
  • David A. Hanley

      Affiliations

    • Department of Medicine, Division of Endocrinology, University of Calgary, Calgary, Alberta
    • ,
  • Jerilynn C. Prior

      Affiliations

    • Department of Medicine, Division of Endocrinology, University of British Columbia, Vancouver, British Columbia
    • ,
  • Lehana Thabane

      Affiliations

    • Department of Health Research Methodology, McMaster University, Hamilton, Ontario
    • Centre for Evaluation of Medicines, Hamilton, Ontario
    • ,
  • E.A. Papadimitropoulos

      Affiliations

    • University of Toronto Faculty of Pharmacy and Eli Lilly Canada, Toronto, Ontario
    • ,
  • Amiram Gafni

      Affiliations

    • Department of Health Research Methodology, McMaster University, Hamilton, Ontario
    • Centre for Health Economics and Policy Analysis, Hamilton, Ontario
    • ,
  • Laura Pickard

      Affiliations

    • Department of Medicine, Division of Rheumatology, St. Joseph's Healthcare, Hamilton, Ontario
    • ,
  • Tassos Anastassiades

      Affiliations

    • Department of Medicine, Division of Rheumatology, Queens University, Kingston, Ontario
    • ,
  • Susan Kirkland

      Affiliations

    • Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia
    • ,
  • Jonathan D. Adachi

      Affiliations

    • Department of Medicine, McMaster University, Hamilton, Ontario
    • Department of Medicine, Division of Rheumatology, St. Joseph's Healthcare, Hamilton, Ontario
    • ,
  • the CaMos Research Group

      Affiliations

    • Canadian Multicentre Osteoporosis Study Research Group, Canada

Received 26 April 2006 ,Revised 17 July 2006 ,Accepted 19 July 2006.

References 

  1. Kanis JA, Borgstrom F, De Laet C, et al. Assessment of fracture risk. Osteoporos Int. 2005;16:581–589
  2. Watts NB. Fundamentals and pitfalls of bone densitometry using dual-energy X-ray absorptiomentry (DXA). Osteoporos Int. 2004;15:847–854
  3. World Health Organization . Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of the WHO study group. World Health Organ Tech Rep Ser. 1994;843:1–129
  4. Brown JP, Josse RG, Scientific Advisory Council of the Osteoporosis Society of Canada . The 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ. 2002;167(10 Suppl):S1–S34
  5. Brown JP, Josse RG, Scientific Advisory Council of the Osteoporosis Society of Canada . Osteoporosis update: a practical guide for Canadian Physicians. Osteoporosis Update (Special Guidelines Issue). 2003;Winter(1):1–19
  6. Lewiecki EM, Watts NB, McClung MR, Petak SM, Bachrach LK, Shepherd JA, et al. Official Positions of the International Society for Clinical Densitometry. J Clin Endo Metab. 2004;89:3651–3655
  7. The International Society for Clinical Densitometry. 2005 The ISCD Official Positions 2005. Website: http://www.iscd.org/Visitors/positions/OfficialPositionsText.cfm. Accessed April 2, 2006.
  8. Cheung AM, Feig DS, Kapral M, Diaz-Granados N, Dodin S, the Canadian Task Force on Preventative Health-Care . Prevention of osteoporosis and osteoporotic fractures in postmenopausal women: recommendation statement from the Canadian Task Force on Preventative Health Care. CMAJ. 2004;170:1665–1667
  9. Nelson HD, Helfand M, Woolf SH, Allan JD. Screening for postmenopausal osteoporosis: a review of the evidence for the US Preventative Services Task Force. Ann Intern Med. 2002;137:529–541
  10. US Preventative Services Task Force. 2002 Screening for Osteoporosis in postmenopausal women: recommendations and rationale. Agency for Healthcare research and Quality, Rockville, MD. Website: http://www/ahrq.gov/clinic/3rduspstf/osteoporosis/osteorr.htm. Accessed April 2, 2006.
  11. National Osteoporosis Foundation. 2006 Osteoporosis: Bone Density. Website: http://www.nof.org/osteoporosis/bonemass.htm. Accessed April 2, 2006.
  12. Siminoski K, Leslie WD, Frame H, et al. for the Canadian Association of Radiologists Recommendations for bone mineral density reporting in Canada. Can Assoc Radiol J. 2005;56:178–188
  13. Cranney A, Guyatt G, Krolicki N, et al., the Osteoporosis Research Advisory Group  A meta-analysis of etidronate for the treatment of postmenopausal osteoporosis. Osteoporos Int. 2001;12(2):140–151
  14. Cranney A, Tugwell P, Zytaruk N, et al., the Osteoporosis Research Advisory Group  Meta-analyses of therapies for postmenopausal osteoporosis. IV. Meta-analysis of raloxifene for the prevention and treatment of postmenopausal osteoporosis. Endocr Rev. 2002;23(4):524–528
  15. Cranney A, Tugwell P, Adachi J, et al., the Osteoporosis Methodology Group and the Osteoporosis Research Advisory Group  Meta-analyses of therapies for postmenopausal osteoporosis. III. Meta-analysis of risedronate for the treatment of postmenopausal osteoporosis. Endocr Rev. 2002;23(4):517–523
  16. Cranney A, Wells G, Willan A, et al., the Osteoporosis Methodology Group, and the Osteoporosis Research Advisory Group  Meta-analyses of therapies for postmenopausal osteoporosis. II. Meta-analysis of alendronate for the treatment of postmenopausal women. Endocr Rev. 2002;23(4):508–516
  17. Cranney A, Guyatt G, Griffith L, Wells G, Tugwell P, Rosen C, et al. Meta-analyses of therapies for postmenopausal osteoporosis. IX. Summary of meta-analyses of therapies for postmenopausal osteoporosis. Endocr Rev. 2002;23(4):570–578
  18. Guyatt GH, Cranney A, Griffith L, Walter S, Krolicki N, Favus M, et al. Summary of meta-analyses of therapies for postmenopausal osteoporosis and the relationship between bone density and fractures. Endocrinol Metab Clin North Am. 2002;31(3):659–679xii
  19. Papapoulos SE, Quandt SA, Liberman UA, Hochberg MC, Thompson DE. Meta-analysis of the efficacy of alendronate for the prevention of fractures in postmenopausal women. Osteoporos Int. 2005;16:468–474
  20. Nguyen ND, Eisman JA, Nguyen TV. Anti-hip fracture efficacy of bisphosphonates: Bayesian analysis of clinical trials. J Bone Miner Res. 2006;21(2):340–349
  21. Hodsman AB, Bauer DC, Dempster DW, et al. Parathyroid hormone and teriperatide for the treatment of osteoporosis: a review of the evidence and suggested guidelines for its use. Endocr Rev. 2005;26(5):688–703
  22. Sawka AM, Papaioannou A, Adachi JD, Gafni A, Hanley DA, Thabane L. Does alendronate reduce the risk of fracture in men? A meta-analysis incorporating prior knowledge of anti-fracture efficacy in women. BMC Musculoskelet Disord. 2005;6:39
  23. Kreiger N, Tenenhouse A, Joseph L, et al. The Canadian Multicentre Osteoporosis Study (CaMos): Background, rationale, methods. Can J Aging. 1999;18(3):376–387
  24. Tenenhouse A, Joseph L, Kreiger N, et al., the CaMos Research Group  Estimation of the prevalence of low bone density in Canadian women and men using a population-specific DXA reference standard: The Canadian Multicentre Osteoporosis Study. Osteoporos Int. 2000;11:897–904
  25. Genant HK, Grampp S, Gluer CC, et al. Universal standardization for dual x-ray absorptiometry: patient and phantom cross-calibration results. J Bone Miner Res. 1994;9(10):1503–1514
  26. Altman DG, Machin D, Bryant TN, Gardner MJ. Statistics with Confidence, 2nd ed. London, UK: British Medical Journal Publisher; 2000;105–10
  27. Statistics Canada. 2002 Profile of age and sex, for Canada, provinces, territories and federal electoral districts (1996 representation order), 2001 census. Website: http://www12.statcan.ca/english/census01/products/standard/profiles/RetrieveProfile.cfm?Temporal=2001&PID=56143&APATH=1&RL=2&IPS=95F0486XCB2001007. Accessed April 3, 2006.
  28. Sawka AM, Thabane L, Papaioannou A, et al., the CaMos Investigators  Health-related quality of life measurements in elderly Canadians with osteoporosis compared to other chronic medical conditions: a population-based study from the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int. 2005;16(12):1836–1840
  29. Kanis JA, Johnell O, Oden A, et al. The use of multiple sites for the diagnosis of osteoporosis. Osteoporos Int. 2006;17(4):527–534
  30. Johnell O, Kanis JA, Oden A, et al. Predictive value of BMD for hip and other fractures. J Bone Miner Res. 2005;20(7):1185–1194
  31. Delmas PD, Rizzoli R, Cooper C, Reginster JY. Treatment of patients with postmenopausal osteoporosis is worthwhile. The position of the International Osteoporosis Foundation. Osteoporos Int. 2005;16:1–5
  32. Kanis JA, Seeman E, Johnell O, Rizzoli R, Delmas P. The perspective of the International Osteoporosis Foundation on the official positions of the International Society for Clinical Densitometry. Osteoporos Int. 2005;16:456–459
  33. Sendi P, Al MJ, Gafni A, Birch S. Optimizing a portfolio of health care programs in the presence of uncertainty and constrained resources. Soc Sci Med. 2003;57:2207–2215
  34. Kanis JA, Johnell O, Oden A, De Laet C, Jonsson B, Dawson A. Ten-year risk of osteoporotic fracture and the effect of risk factors on screening strategies. Bone. 2002;30(1):251–258
  35. Kanis JA, Johnell O, Oden A, Borgstrom F, Johansson H, De Laet C, et al. Intervention thresholds for osteoporosis in men and women: a study based on data from Sweden. Osteoporos Int. 2005;16(1):6–14
  36. Sanders KM, Nicholson GC, Watts JJ, Pasco JA, Henry MJ, Kotowicz MA, et al. Half the burden of fragility fractures in the community occur in women without osteoporosis. When is fracture prevention cost-effective?. Bone. 2006;38(5):694–700
  37. Kmetic A, Joseph L, Berger C, Tenenhouse A. Multiple imputation to account for missing data in a survey: estimating the prevalence of osteoporosis. Epidemiology. 2002;13(4):437–444

PII: S1094-6950(06)00239-3

doi: 10.1016/j.jocd.2006.07.004

Journal of Clinical Densitometry
Volume 9, Issue 4 , Pages 413-418 , October 2006

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