Correlation between patient recall of bone densitometry results and subsequent treatment adherence

Abstract

Treatment of osteoporosis is often inadequate. One reason can be insufficient patient education following diagnostic bone densitometry (DXA). Therefore, we studied how patients are informed and treated following their first DXA. Individuals who had DXA at a rural hospital in Wisconsin were surveyed with a questionnaire regarding their post-test education and prescribed treatment. Their DXA results and the specialty of their clinician were also recorded. Eighty percent of the 1,014 participants were informed of their results. Of the 341 participants who had normal bone mineral density (BMD), 63% reported correct results, while only 31% of the 309 who had osteopenia and 50% of the 364 who had osteoporosis reported correct results. Accuracy in reporting was not affected by the patients' age or the specialty of their clinicians. Following DXA, 339 patients (33%) were started on medications; 86% of those remained on some prescribed therapy for osteoporosis, but 140 (41%) did not continue the initial medication. Reasons for discontinuation included side effects (48%) and cost (26%). Patients with low BMD who correctly reported their results were more likely to have received a medication and to continue to take it ( p <0.0001). Calcium supplements were recommended to 65% of those not taking calcium prior to DXA. Internists were more likely than family practitioners to recommend calcium, and their patients reported better medication adherence, as did those with osteoporosis compared with osteopenia. We conclude that, while most participants are informed of the results of their DXAs, the retained information may not be accurate. Correct understanding of DXA results may lead to higher treatment rates and better adherence to treatment among patients with low BMD.

Osteoporosis pharmacotherapy following bone densitometry: importance of patient beliefs and understanding of DXA results

“…We are also limited by lack of control group, and by a small sample size of patients who discontinued treatment. Nonetheless, our study supports prior investigations of the critical importance of patient understanding of DXA results, a possibly modifiable factor in improving subsequent adherence to treatment [15]. Further analysis of perception of osteoporosis treatment is needed, as there may be other possible benefits and barriers to treatment that we did not include.…”

“…Better patient understanding of diagnosis following DXA examination has previously been linked to higher treatment rates and better adherence with the recommended treatment [15,22,23]. This is an important concern as poor refill compliance is associated with significantly higher risk of fractures [24].…”

“…Predictors of correct understanding included younger age and current glucocorticoid use. We were encouraged to find that of all respondents, only 4% were not aware of DXA results, fewer than reported by other investigators assessing selfreport after bone densitometry, where results were not communicated in writing to the patient and GP [14][15][16]25].…”

“…Regrettably, prior studies have showed at best only moderate agreement between self-reported and actual DXA results [14,15]. This is unfortunate for two reasons.…”

Medication Adherence

“…Only 63% of the 341 participants with a normal BMD, 31% of the 309 patients with osteopenia, and 50% of the 364 patients with a diagnosis of osteoporosis reported the results correctly. 23 Patients with a low BMD (i.e., osteopenia or osteoporosis) who were able to correctly report their results were significantly more likely to have received a medication and continue to take it than patients who incorrectly reported their results.…”