Patterns of bone mineral density testing

Abstract

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.

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

“…A study of approximately 1,000 women in a single regional health maintenance organization 22 and another in a single academic medical system 23 also found low rates of bone density testing even in patients at high fracture risk. Several studies have found that osteoporosis recognition is low even in patients with fractures 24,25 . Initiation of osteoporosis treatment after fracture was less than 25% in most studies, and empirical treatment (that is, without bone density testing) was even less frequent 26…”

Understanding Referral Patterns for Bone Mineral Density Testing among Family Physicians: A Qualitative Descriptive Study

“…One potential explanation for this care gap is the multiple sources of recommendations for BMD testing which do not always agree with the 2010 Canadian CPGs for the diagnosis and management of osteoporosis [ 1 ]. A recent survey of screening for and treatment of osteoporosis identified 24 different sets of published clinical guidelines for BMD testing [ 9 ]. In Ontario, the situation is further confounded by the fact that the current physician fee schedule still refers to the 2002 Canadian CPGs for the diagnosis and management of osteoporosis [ 10 ] which do not emphasize fracture risk or provide clear guidance for referral of high fracture risk patients even though reimbursement policies were changed in 2008 [ 11 ].…”

Health beliefs about osteoporosis and osteoporosis screening in older women and men

“…In the National Ambulatory Medical Care Survey, investigators found that primary care physicians diagnosed osteoporosis in fewer than 2 per cent of women over 60 years old, even though the expected prevalence in this population is 20 to 30 per cent 11 . Men appear to be diagnosed and treated less often than women 12,13 . Several groups have endorsed osteoporosis screening in older adults.…”