Bindex for investigating suspected osteoporosis

Patient organisation comments

The National Osteoporosis Society gave the following comments.

Quantitative ultrasound technologies, such as Bindex, are quick and portable and have been used as a method of triaging patients for dual‑energy X‑ray absorptiometry (DXA). However, they noted that as quantitative ultrasound does not measure bone mass density, it cannot be used to diagnose osteoporosis as currently defined by bone mass density or bone mineral content. Online tools recommended in the NICE guideline on osteoporosis can incorporate measurements from DXA to improve fracture risk assessment, but the tool is not able to include quantitative ultrasound measurements.

They felt that Bindex would not streamline the diagnosis of osteoporosis, but instead would be an extra assessment and another appointment. People with a high-risk result from Bindex would still need a DXA scan to establish a baseline measurement to monitor treatment efficacy. Bindex cannot measure changes in bone mass, and so people who are having treatment for osteoporosis after a high risk Bindex result, but do not have a baseline DXA scan, will have delayed treatment monitoring.

The patient organisation stated that some people may prefer Bindex to online fracture risk assessment tools and may see it as more rigorous. They said that information is shown in an aesthetically pleasing way on the screen, but it is unclear how easily the user or the patient would understand the results (for example, how risk thresholds are described by the tool).

The organisation recommended that Bindex is operated by staff trained in the use of quantitative ultrasound devices and that the results should be interpreted by a clinician with knowledge of osteoporosis management in healthcare settings (including community settings, care homes and home visits). They noted that the licensing is based on a cost per analysis, suggesting that Bindex would need to be done in dedicated clinics to be cost effective. This negates the advantage of being able to use Bindex in any setting.

They expressed concern about the lack of data for predicting fracture risk. Based on the proposed triage pathway, treatment management would be based on a measurement that has not been prospectively validated to predict fracture risk. Also, the data is limited because the intervention thresholds were taken from studies in Finnish women of white European family origin and cannot be extrapolated to other populations.

Bindex measurements correlate with DXA measurements, however the technology does not assess bone mass density and therefore the measurements cannot be assumed to be interchangeable. Further validation of the measurements in prospective fracture studies and wider populations are needed. According to the National Osteoporosis Society, Bindex does not add enough information or improvement to justify modification to the diagnosis pathway for osteoporosis.