Hi, I was wondering if there has been any recent recommendations or studies done on how often you should perform a dxa scan or BMD testing after starting a patient on osteoporosis treatment. According to up to date, "Consider repeat BMD testing one or two years after starting pharmacologic therapy, as soon as six months after starting glucocorticoid therapy, or perhaps never if very little change is expected..." but according to the mini clinical trials that I have been able to dig up, there just does not seem to be any evidence backing up the two-year interval thing. Anybody can give me any more information? thank you very much!
dxa scan after starting treatment for osteoporosis
- Thread starter tymlos
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On the one hand, ACP guidelines say no repeat bone density scan while on treatment, just treat them for 5 years and check one after.
On the other hand, every single society that is made up of actual bone specialists, including the American Society of Bone and Mineral Research, American Association of Clinical Endocrinology, and (I think) the Endocrine Society has come out to say that recommendation is stupid and you should check a repeat DXA 1-2 years after initiation of therapy.
The reasoning is simple: You want to see if it's working. If someone is on therapy and their bone density is still getting significantly worse, you might want to change to a different form of therapy. If their bone density is stable/improving, it makes you feel better. The data behind the approach might not be the strongest ever, but it certainly makes sense. Unless you think all the Endocrinologists interpreting DXAs are in it for the money
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Even if they are in it for the $$$, they're doing it wrong. DEXA costs <$500 full cash pay, ~$150 with insurance and most folks will pay $25 or nothing depending on how good the billing/coding folks are. A year of Zometa or Fosamax costs ~$1200.On the one hand, ACP guidelines say no repeat bone density scan while on treatment, just treat them for 5 years and check one after.
On the other hand, every single society that is made up of actual bone specialists, including the American Society of Bone and Mineral Research, American Association of Clinical Endocrinology, and (I think) the Endocrine Society has come out to say that recommendation is stupid and you should check a repeat DXA 1-2 years after initiation of therapy.
The reasoning is simple: You want to see if it's working. If someone is on therapy and their bone density is still getting significantly worse, you might want to change to a different form of therapy. If their bone density is stable/improving, it makes you feel better. The data behind the approach might not be the strongest ever, but it certainly makes sense. Unless you think all the Endocrinologists interpreting DXAs are in it for the money
So a (let's just say for the sake of argument) $250 test, to prove that your $1200/yr x5y (=$6K) therapy has been effective, after a year or two, seems like a pretty good use of resources.
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well, alendronate at the Wal Mart is $24 for 90 days....
but agree with Raryn...ASBMR stated that the new ACP guidelines "fall short" in key tenets of osteoporosis treatment and management...and AACE and ACE agreed with them.
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Zolendronic acid is down to $50-$100 per 4mg vial. Even if you're using the 5mg dose (which is the correct one for osteoporosis) and have to break (and pay for) a second 4mg vial AND you tack on an infusion fee, it's not actually that expensive anymore. (It's ridiculous that the generic manufacturers won't just make a 5mg vial...)
Went generic maybe three or four years ago. Still requires a prior auth the majority of the time of course, but I've never had it denied.
