Osteoporosis is one of the most painful and costly diseases in the world. By early identification of patients at high risk of osteoporotic fractures, treatment can be initiated that slows down disease development. Treatment is cheap in comparison to the cost for fractures and it is possible that society can even save money from screening women for osteoporosis and thereby prevent fractures.
Sectra OneScreen is a cost-effective online service allowing women to assess their bone health at the mammography examination.
Postmenopausal women are at greatest risk for osteoporosis and, with this new service, they can easily combine their regular mammography examination with screening for osteoporosis at the same visit. Osteoporosis affects approximately one in three women and one in five men over the age of 50. It is a heavily under-diagnosed disease and there is a need of a simple way to find patients who are in need of treatment. There is cheap treatment (so called bisphosphonates) available, but since those in need of treatment are seldom identified due to a lack of cost-efficient methods to measure bone mineral density (BMD), the use of bisphosphonates is very low. However, by using Sectra’s service and combining it with a questionnaire on other risk factors for osteoporosis, patients with high risk of fracture can easily be found and treatment can be initiated.
Low BMD is a risk factor for fractures of for example the hip, spine and forearm; the three typical low-energy fractures associated with osteoporosis. From a regular hand X-ray image, it is possible to estimate the BMD, using Sectra’s online service.
Sectra’s service for BMD assessment is based on the patented DXR (Digital X-ray Radiogrammetry) technique. In those days, the BMD was manually estimated by looking at analogue X-ray image of the forearm. Today, the BMD is estimated by an algorithm and the technique is fully digital. A hand X-ray is acquired in the clinic and sent via the Internet to the Sectra online lab. The BMD of the three central metacarpal bones are estimated and the result, in g/cm2 as well as a comparison to normal reference material is sent via email to a chosen address. The reports can be sent as individual reports or as a sortable spreadsheet where those in need of further investigation or treatment can easily be found.
There is potential in all countries with mammography programs to introduce osteoporosis screening. Since postmenopausal women compose a risk group for osteoporosis and since they are already part of the functioning mammography programs, they are a good target group also for osteoporosis screening. The service for BMD assessment has shown to fit well into the workflow of mammography. After the four breast images included in the mammography examination, an image of the hand is acquired, using the same equipment. Since the woman is already standing by the modality, this adds only approximately 40 seconds to the examination time. The combined examinations increase the value of the mammography program and today, women in for example England, Germany Italy, Norway and Sweden are offered a BMD assessment by Sectra’s service in combination with mammography.
In Sweden, a large study with 10,000 women is currently performed together with the Karolinska Institute and Unilabs. The study has shown that also in high volume screening, the extra hand image has only minor effect on the mammography workflow. This means that mammography and BMD assessment with Sectra’s service can efficiently be combined.
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