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OBJECTIVES:To identify potential obstacles to bone mineral density (BMD) testing, we performed a structured review of current osteoporosis screening guidelines, studies of BMD testing patterns, and interventions to increase BMD testing. DESIGN:We searched MEDLINE and HealthSTAR from 1992 through 2002 using appropriate search terms. Two authors examined all retrieved articles, and relevant studies were reviewed with a structured data abstraction form. MEASUREMENTS AND MAIN RESULTS:A total of 235 articles were identified, and 51 met criteria for review: 24 practice guidelines, 22 studies of screening patterns, and 5 interventions designed to increase BMD rates. Of the practice guidelines, almost one half (47%) lacked a formal description of how they were developed, and recommendations for populations to screen varied widely. Screening frequencies among at-risk patients were low, ranging from 1% to 47%. Only eight studies assessed factors associated with BMD testing. Female patient gender, glucocorticoid dose, and rheumatologist care were positively associated with BMD testing; female physicians, rheumatologists, and physicians caring for more postmenopausal patients were more likely to test patients. Five articles described interventions to increase BMD testing rates, but only two tested for statistical significance and no firm conclusions can be drawn. CONCLUSIONS:This systematic review identified several possible contributors to suboptimal BMD testing rates. Osteoporosis screening guidelines lack uniformity in their development and content. While some patient and physician characteristics were found to be associated with BMD testing, few articles carefully assessed correlates of testing. Almost no interventions to improve BMD testing to screen for osteoporosis have been rigorously evaluated.

Evidence exists that many at-risk patients are not screened or receive appropriate therapy for osteoporosis. We reviewed studies of bone mineral density (BMD) testing and osteoporosis therapy to describe predictors associated with screening and treatment of osteoporosis. We performed a structured review, searching MEDLINE and HEALTHStar from 1992 through 2002 using appropriate terms. Two authors examined all retrieved articles, and relevant studies were reviewed with a structured data abstraction form. A total of 277 articles were identified, and 35 met criteria for this review. Of these, 22 described screening patterns and 28 described treatment patterns. Seventy-one percent (25 of 35) of papers examined correlates of either BMD testing or treatment, and half (51%, 18 of 35) used multivariable analyses. Male patient gender and lack of subspecialist care were consistently associated with a higher risk of not receiving BMD testing; male physicians, generalist doctors, and those caring for fewer postmenopausal patients were more likely not to test patients. Younger patients, men, patients without a history of fracture, and those without subspecialist care were at higher risk of not receiving pharmacologic treatments. Six studies that examined treatment frequencies after bone densitometry all found that patients with osteoporosis by bone densitometry were at lower risk of not receiving treatment. Although the current literature is limited by inconsistent inclusion of common covariates and a lack of multivariable analyses, information about patient and physician correlations of osteoporosis management should help inform future quality improvement initiatives. Learning Objectives• Recall reported US rates of screening for osteoporosis by bone mineral density (BMD), and of treatment of bone fracture patients for osteoporosis. • Relate both patient-and physician-associated factors to the likelihood that BMD screening will be carried out. • Identify those factors that predict whether or not an osteoporotic patient will be treated.O steoporosis and resultant fractures are a large and growing public health issue. More than 300,000 hip fractures occur annually in the United States. 1 Screening for osteoporosis, primarily with bone mineral density (BMD) testing, permits prediction of future fractures among white women. [2][3][4] In patients with osteoporosis, there are effective pharmacologic treatments; several widely available therapies reduce future fractures in at-risk populations by 40% to 50%. [5][6][7] However, there is evidence that screening and treatment could not be reaching at-risk populations. Studies of medical records in the United States have reported BMD rates of only 3% to 14% in patients with previous fractures 8,9 and 19% to 23% of glucocorticoid users. 10,11 These rates are similar to those reported in other countries. 12 Treatments for osteoporosis also appear to be underused. Among 14 studies of patients who had sustained a fracture, mean treatment rates were low: calcium supplements were taken by 19...

State Medicaid prior authorization policies for coxibs are heterogeneous in terms both of the criteria required to obtain a coxib and of the relationship of those criteria to clinical evidence. Development of clinically rational prescription drug policies should be a goal for all health insurers and represents an important priority for Medicare's prescription drug benefit program.