Dual X-Ray Absorptiometry of the Lumbar Spine but not the Hip: Any Problems with a Swiss Policy?

Introduction: Osteoporosis is a growing healthcare problem in societies with aging populations and DXA is increasingly important to evaluate patients at risk and measure effects of osteoporosis treatment. In Switzerland, as in most Western countries, growing expense of public healthcare forces public authorities to take cost-saving action. The restriction of reimbursement for DXA measurement of the hip might impact negatively on patient care. Methods: We retrospectively evaluated data of 770 patients (59.3 ± 14.6 years, 14 - 91 years; 91 male and 679 female) and analyzed the proportion of patients with low bone mass as based on DXA measurements of a hip/spine combination of measurements or a single measurement of the lumbar spine. Results: There was a significant number of discordant measurements of T-score values between lumbar spine and total hip compared to concordant measurement results in all patients (p<0.0001) and in postmenopausal women (p<0.0001). Conclusion: DXA measurement of the lumbar spine only may miss correct diagnosis of osteopenia or osteoporosis in a significant number of patients. Therefore, it is important to examine both lumbar spine and hip in order to maintain patient care standards.