No abstract

To determine physician characteristics associated with the use of bone densitometry (BD), we conducted a cross-sectional survey of primary care practitioners in an urban community hospital. Participants were internists, geriatricians, and family practitioners. Seventy-two percent of the physicians never used BD. There was no association between physician or practice characteristics and BD use. Bone densitometry users were more likely than nonusers to treat their patients with osteoporosis or at risk of developing it. Self-reported barriers to use included cost, unfamiliarity with guidelines, uncertainty with clinical applicability, minimal impact on treatment decisions, and availability. In conclusion, although it has been shown that osteoporotic women who are aware of their BD results are more likely to accept treatment, further attention should be paid to primary care practitioners' attitudes, knowledge, and behavior regarding the use of BD in the management of osteoporosis. steoporosis is believed to result in at least 1.3 million fractures in the United States each year. 1 These fractures result in significant morbidity and mortality in the fastest growing segment of our population, the elderly. Because of this, osteoporosis is a significant health concern that may eventually cost the United States between $4 billion and $60 billion a year. 2,3 Efforts aimed at maintaining bone mass are considered crucial in decreasing the risk of fractures. [3][4][5][6] Several studies have shown that for 1 SD decrement in bone mass, fracture risk increases as much as 50% to 100%. 4 Recently, the efficacy of the bisphosphonate alendronate was demonstrated by documenting a 48% reduction in vertebral fracture rates in conjunction with a 9% increase in bone density. 7 The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial also demonstrated as much as a 5% increase in bone mineral density with hormone replacement therapy. 8 Bone mass can now be measured in a safe, reliable and accurate manner using bone densitometry (BD), especially with the development of dualenergy x-ray absorptiometry (DEXA). 9 Bone densitometry may have an expanded role in the management of patients with osteoporosis, especially given the multiple options for treatment. [10][11][12] Because screening all perimenopausal women is costly, several experts have published selective screening practice guidelines for women at high risk of osteoporosis: women with estrogen deficiency considering replacement therapy, patients with radiographic abnormalities suggesting osteoporosis, patients on longterm glucocorticoid or anticonvulsant therapy, and patients with primary hyperparathyroidism. 9,13-18 However, there is no evidence linking BD use with reduced fracture incidence.Rubin and Cummings reported that women's knowledge of their BD results influenced their decision to accept therapy for osteoporosis. 19 It has not previously been reported whether the physician's knowledge of patients' BD results influences treatment recommendations.Given the uncertain ut...

Personalized education and case management are successful in enhancing compliance with breast cancer screening among historically noncompliant vulnerable urban women. This intervention, when combined with a preventive care information system, has the potential to achieve Healthy People 2000 objectives for breast cancer screening.