Factors Associated with Osteoporosis Screening and Recommendations for Osteoporosis Screening in Older Adults

Abstract

BACKGROUND: Osteoporosis screening rates are low, and it is unclear which patient factors are associated with screening and physician recommendations for screening. OBJECTIVE:To identify patient characteristics associated with osteoporosis screening recommendations and receipt of screening in older adults. DESIGN:Cross-sectional mailed survey. PARTICIPANTS:Women and men ≥60 years old living in or near western Pennsylvania.MEASUREMENTS: Sociodemographic characteristics and osteoporosis-related data, including risk factors, physician recommendations for screening, and receipt of screening. Multivariable logistic regression analyses were performed to determine odds ratios for receipt of screening and screening recommendations for individuals with particular osteoporosis risk factors, adjusting for sociodemographic and other risk factors.RESULTS: Surveys were completed by 1,268 of the 1,830 adults to whom surveys were mailed (69.3%). Most respondents were white (92.9%), female (58.7%), and believed they were in good to excellent health (88.2%). Only 47.6% said their physician recommended osteoporosis screening, and 62.6% of all respondents reported being screened. Screening recommendations were less likely for older respondents than younger ones (OR, 0.87 per 5-year increase in age; 95% CI, 0.77-0.97). Individuals with osteoporosis risk factors of a history of oral steroid use for >1 month, height loss >2.54 cm, or history of low-trauma fracture were no more likely to report screening recommendations than individuals without these characteristics. Receipt of screening was no more likely for more elderly respondents or respondents with a history of oral steroid use for >1 month than for respondents without these characteristics.CONCLUSIONS: Individuals with several known osteoporosis risk factors are not being sufficiently targeted for screening.

Assessing osteoporosis risk factors in Spanish menopausal women

“…The publications describe in detail the importance of these risk factors in the development of the disease. These results fully coincide with other authors who have applied this kind of analysis in their studies [7,9,32], although they differ partially from those obtained by other authors in Spain [33], who used the heel quantitative ultrasound technique as an bone mineral density (BMD) reading. Some investigators [34,35] also mention smoking and alcohol as important factors associated with a higher incidence of this disease, although we were unable to confirm this point.…”

“…The study of osteoporotic fractures, a large, prospective US study, identified 14 clinical risk factors for osteoporotic hip fracture in multivariable models: age, maternal hip fracture, personal history of any fracture from the age of 50, height, poor self-rated health, no weight gain, hyperthyroidism, not walking for exercise, lack of ambulation, inability to rise from a chair, poor vision, high resting pulse, and current use of benzodiazepines, anticonvulsants, or caffeine [9].…”

Use of a clinical decision support system to increase osteoporosis screening

“…The mean rate of screening in one primary care group practice was 56% [12]. Less than 50% of 1200 adults aged 60 years or older surveyed in the north-eastern USA said that their doctor recommended osteoporosis screening [13].…”

Changing trends in osteoporosis care from specialty to primary care physicians

“…The increasing number of outpatient visits that addressed osteoporosis is a testimony of increasing need and demand for osteoporosis care in older patient population. Growing numbers of older people with multiple co-morbidities in the USA 26 continue to increase demand on PCPs for continuity of care for chronic diseases 14,27 . Osteoporosis, a chronic disease of old age demands similar care with continuation and hence the role of PCPs is important in managing this bone disease.…”