Feb 28 2005
In an editorial in the February 28 issue of Archives of Internal Medicine, Alan L. Buchman, M.D., M.P.H., of the Feinberg School of Medicine at Northwestern University, Chicago, writes that the primary reason to diagnose and treat osteoporosis is to prevent bone fractures.
"Low bone mineral density (BMD) is associated with increased fracture risk, and increased BMD during therapy is associated with a corresponding decrease in fracture risk. However, BMD is only one factor that contributes to bone strength and fracture risk in spine and hip."
"Given that most bone mass is achieved by age 18 years, and setting aside cost for the moment, it may be prudent to screen the entire population of high-risk individuals (white girls) during childhood or adolescence, prior to development of osteoporosis or osteopenia," Dr. Buchman writes. "Even patients diagnosed as having celiac disease before menopause have more significant improvements in BMD that those diagnosed after menopause. However, one must evaluate the cost not just to identify an asymptomatic individual with celiac disease, but also to prevent a fracture."
"The cost to prevent a single fracture in a patient with celiac disease and osteoporosis would be $43,000 (similar to the cost of screening mammography to detect a breast cancer)," Dr. Buchman states. "This cost would be far greater for a patient with osteopenia, to say nothing of a population screen." Dr Buchman also points out that, "Not all investigations have reported an increased prevalence of celiac disease in individuals with osteoporosis or an increased fracture risk in patients with celiac disease."
"However, the questions remain: Who should be screened for celiac disease? And at what cost? The data from Stenson et al raise an important issue, but given the variations in study findings and cost estimates, it is impossible to make a clear recommendation for celiac disease screening in a population even as defined as those with osteoporosis," Dr. Buchman concludes. "As is often the case, further study is indicated."