Bone Density Testing in Older Women and Its Association with Patient Age

Abstract

In the 3 years after Medicare reimbursement for osteoporosis screening began, adoption of bone density testing was lowest in women in age groups at highest fracture risk.

Racial and Socioeconomic Disparities in Bone Density Testing Before and After Hip Fracture

“…[1][2][3]26,27 These findings may have some legitimate explanations. Black and Hispanic women have a lower incidence of hip fracture and likely fewer fracture risk factors, and the predictive ability of BMD testing in these groups is not as well-studied as in white women.…”

“…Previous studies have found 20-50% lower use of bone density screening for black women, and 23% less testing for Hispanic women. [1][2][3] Racial differences in screening are generally interpreted as indicators of poorer quality of care. 4 However, there are possible legitimate explanations for racial differences in osteoporosis screening among women who have not had a fracture.…”

A Captive Audience: A Pilot Study of Screening and Counseling Hospitalized Women for Fracture Risk

“…2 Patient and provider factors contribute to failure to participate in screening, 3 and obtaining a DXA may be inconvenient if it requires a separate clinic appointment or a physician referral. This may be problematic for older women or women with multiple comorbidities, who are less likely to receive a DXA, 3,4 suggesting that more innovative methods may be required to reach them. The purpose of this study was to develop and pilot test a novel approach to screening high-risk women for osteoporosis.…”

A Randomized Study of the Effect of 5-Year and Lifetime Hip Fracture Risk Information on Physician Recommendations for Management of Low Bone Density

“…Current osteoporosis treatment decisions do not correlate well with objective measures of patient fracture risk. Specifically, osteoporosis appears to be underrecognized and under-treated in older patients (5,6), patients with multiple osteoporosis risk factors (7), and patients with prior fractures (8)(9)(10). It is not known whether there is widespread treatment of lower-risk patients, but by one estimate nearly 13% of women over 65 are receiving osteoporosis treatment (11).…”