Are you suffering from the problem of fragile and weak bones?? If yes, you may have osteoporosis. The diagnosis of this issue is very crucial. For its diagnosis, various techniques are used such as MRI, DXA and CT (computed tomography) scan. The risk of fracture is more likely to diagnose by measuring BMD (bone mineral density), which is commonly assessed by performing DXA (dual-energy x-ray absorptiometry). Scientists now want to evaluate whether CT in combination with DXA is cost-effective as a screening tool for bone strength among postmenopausal women or not. 

For the study, an osteoporotic state-transition microsimulation model for postmenopausal women was developed. This was developed with a lifetime horizon and U.S. societal perspective. The women who selected for study was about 55 years old or older than 55. Published literature was used to derive all model inputs. Scientists categorized study into three parts for comparison – no screening, DXA with T score-dependent rescreening intervals, and DXA and quantitative CT combination at different screening initiation age along with different time intervals (3, 5, and 10 years). During evaluation, the participants who had low DXA hip T scores, 10-year hip fracture risk more than 3%, 10-year major osteoporotic fracture risk more than 20%, in case of first fracture, or quantitative CT femur bone strength was lower than 3000 N, were known to provide oral bisphosphonate therapy. The outcomes involved in the study were number of fragility fractures and ICERs (incremental cost-effectiveness ratios) in 2015 U.S. dollars per quality-adjusted life year (QALY) gained. Scientists also executed Probabilistic sensitivity analysis.

According to result evaluation, combined DXA and quantitative CT screening cost-effective strategy was starting at 55 age that followed every 5 years.  This strategy helped in sustaining hip fractures among 12.8% of postmenopausal women in their remaining life. Except this, other types of fractures were also evaluated. The vertebral fracture percentages that came out was 7.5% for DXA and quantitative CT with a 5-year interval, 11.1% during no screening and 9% for DXA screening; for wrist fractures 14%, 17.8%, and 16.4% and for other fractures the percentage was 22.6%, 30.8%, and 27.3%, respectively. Further, during probabilistic sensitivity analysis, the DXA and quantitative CT at age 55 years with quantitative CT screening at every 5 years determined as the best strategy in more than 90% of all 1000 simulations. This can be seen from thresholds values which was  $50 000 per QALY at age of 55 and $100 000 per QALY after 5 years.

This whole study is very helpful in evaluating cost-effectiveness. This combined DXA and quantitative CT strategy is very cost-effective for screening osteoporosis among postmenopausal women.