USO Y SOBREUSO DE LA DENSITOMETRÍA ÓSEA COMO MÉTODO DE SCREENING DE OSTEOPOROSIS

RESUMEN introduccion La osteoporosis se define como la desviacion de 2,5 del valor de masa osea por densitometria osea (DMO) de acuerdo al estandar en mujer joven (T score menor o igual a 2,5). La U.S. Preventive Services Task Force (USPSTF) recomienda su busqueda en todas las mujeres mayores a 65 anos y en aquellas con alto riesgo de fractura. objetivo Determinar el impacto del seguimiento por medicos especialistas sobre la solicitud incorrecta de densitometria osea en mujeres de 50-60 anos. MATERIAL Y METODOS Realizamos un estudio de casos y controles definiendo casos (mediante muestreo aleatorio simple) como pacientes de sexo femenino entre 50-60 anos, a quienes se le solicito incorrectamente DMO y controles como mujeres del mismo rango etario y que consultaron en el mismo periodo de tiempo a quienes NO se les solicito DMO en forma incorrecta (DMOni: DMO correcta o sin DMO) de 2011 y 2012. Se utilizaron los criterios de la USPSTF en base al riesgo calculado mediante FRAX. Se registro a que servicio pertenecian el/los medicos que estaban realizando el seguimiento. resultados Se analizaron 88 pacientes en el grupo DMOni (87 mujeres sin DMO solicitada, 1 con DMO correctamente solicitada) y 45 del DMOi. El seguimiento por alguna especialidad se asocio a una tendencia en el aumento de DMOi: OR 6,28 (IC95 % 0,79 – 134), p = 0,058. CONCLUSIONES El seguimiento por la especialidad Clinica Medica se relacionaria con el cumplimiento de las recomendaciones de solicitud de DMO; el seguimiento por especialidades, aumentaria la chance de que no se cumplan recomendaciones. PALABRAS CLAVE densitometria, osteoporosis, rastreo, sobrediagnostico. USE AND OVERUSE OF BONE DENSITOMETRY AS OSTEOPOROSIS SCREENING METHOD ABSTRACT introduction Osteoporosis is defined as bone mineral density of 2.5 standard deviations below the mean peak bone mass (average of young, healthy adults) as measured by dual-energy X-ray absorptiometry (DXAs). The U.S. Preventive Services Task Force (USPSTF) recommends the systematic search for osteoporosis for all women age 65 and older, and those under that age with risk of fracture equivalent to these women in 10 years. OBJECTIVE To measure the impact of follow up by specialists on the incorrect indication of bone densitometry for women 50-60 years of age. MATERIAL AND METHODS We conducted a case-control study. We defined as cases women aged 50-60, whose physicians incorrectly indicated DXA scan (iDXAs) between 2011 and 2012 and as controls women with the same age who consulted whose physicians did not indicated incorrectly DXAs (cDXAs: DXAs indicated properly or without DXAs). To define whether the densitometry was indicated properly we used the criteria proposed by the USPSTF based on the FRAX tool. We retrospectively registered the medical specialties treating the patient (Endocrinology, Gynecology, Rheumatology, Orthopedics, Oncology or other). RESULTS 88 patients in the cDXAs group were analyzed (87 women without DXAs solicited and 1 with a DMO correctly solicited) and 45 in de group iDXAs. Follow up by a non gereral-physician (Gynecology,Endocrinology, Rheumatology, and Orthopedics) was associated with a trend to more iDXAs (OR 6.28 iDXAs - 95% CI 0,79 – 134), p: 0,058. The univariate analysis showed that follow-up by Endocrinology and Gynecology was associated with a significant raise of iDXAs: OR of 2.45 (95% CI 1.07-5.79) and 2.5 (IC 95% 1.13-5.62) respectively. conclusions Follow-up by General Practitioner would relate to a better adherence to the USTF`s recommendations, while follow-up by other specialties show an increased chance that such recommendations are not met. KEY WORDS Densitometry, Osteoporosis, screening, overdiagnosis.