Appropriateness of referrals to a tertiary referral centre for bone mineral density testing

Akheel, Mohammad; Aamir, Mohd.; Mooney, Sarah; Coughlan, Robert J.; Carey, John J.

doi:10.1007/s11845-013-1044-5

Cited by 9 publications

(8 citation statements)

References 24 publications

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“…Access to quality DXA scanning and diagnostics is a global prerogative for those at high risk for, or with osteoporosis (16). Unfortunately access is limited in many parts of the world (18,(35)(36)(37), and quality receives less attention (16,17). Although many guidelines recommend DXA testing for patients with diseases or those taking medications which are known to increase the risk of bone loss or fracture, deciding who should be screened for osteoporosis is more contentious (7,13,14).…”

Section: Discussionmentioning

confidence: 99%

“…An audit of 7,187 DXA referrals over a 4 year period at one clinical site (MPH) shows that the majority of patients are referred from primary care clinics (69%) and hospital outpatient specialist clinics (27%), whilst <4% are referred from inpatient services. Our analyses of >2,000 of those referrals during this period, have previously been published including details of the indications for DXA on the request (35).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Utility of Osteoporosis Self-Assessment Tool as a Screening Tool for Osteoporosis in Irish Men and Women: Results of the DXA-HIP Project

Erjiang

Wang

Yang

et al. 2021

Journal of Clinical Densitometry

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Utility of Osteoporosis Self-Assessment Tool as a Screening Tool for Osteoporosis in Irish Men and Women: Results of the DXA-HIP Project

Erjiang

Wang

Yang

et al. 2021

Journal of Clinical Densitometry

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“…In a systematic review of practice patterns in the management of osteoporosis after fragility fracture, BMD testing was performed in less than 15% of patients with recent fractures in 15 of 23 studies [19]. Most recently, in a sample of 2,025 BMD referrals (using the International Society for Clinical Densitometry guidelines), compared to those deemed appropriate, inappropriate referrals were more likely to have had less/missing information [21]. Thus, implementation of the RUR holds potential to ensure the consistent capture of clinical information necessary to make appropriate referrals.…”

Section: Discussionmentioning

confidence: 99%

Acceptability and Feasibility of an Evidence-Based Requisition for Bone Mineral Density Testing in Clinical Practice

Munce

Butt

Anantharajah

et al. 2016

Journal of Osteoporosis

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Introduction. The purpose of this study is to understand the experience of primary care providers (PCPs) using an evidence-based requisition for bone mineral density (BMD) testing. Methods. A qualitative descriptive approach was adopted. Participants were given 3 BMD Recommended Use Requisitions (RUR) to use over a 2-month period. Twenty-six PCPs were interviewed before using the RUR. Those who had received at least one BMD report resulting from RUR use were then interviewed again. An inductive thematic analysis was performed. Results. We identified four themes in interview data: (1) positive and negative characteristics of the RUR, (2) facilitators and barriers for implementation, (3) impact of the RUR, and (4) requisition preference. Positive characteristics of the RUR related to both its content and format. Negative characteristics related to the increased amount of time needed to complete the form. Facilitators to implementation included electronic availability and organizational endorsement. Time constraints were identified as a barrier to implementation. Participants perceived that the RUR would promote appropriate referrals and the majority of participants preferred the RUR to their current requisition. Conclusions. Findings from this study provide support for the RUR as an acceptable point-of-care tool for PCPs to promote appropriate BMD testing.

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“…A prior audit of > 7000 DXA referrals for our centre shows 69% are referred from primary care, 27% from hospital specialist clinics and 4% from inpatient services. Referrals are accepted per ISCD indications, or sent back to the referring clinician if more information is required or there is no appropriate indication [38]. Accepted referrals are then prioritised as 'urgent', 'soon', or 'routine' depending on the information provided and our impression of where the results are most likely to have the greatest clinical impact.…”

Section: Methodsmentioning

confidence: 99%

Vertebral Fractures in Ireland: A Sub-analysis of the DXA HIP Project

et al. 2021

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Osteoporosis is an important global health problem resulting in fragility fractures. The vertebrae are the commonest site of fracture resulting in extreme illness burden, and having the highest associated mortality. International studies show that vertebral fractures (VF) increase in prevalence with age, similarly in men and women, but differ across different regions of the world. Ireland has one of the highest rates of hip fracture in the world but data on vertebral fractures are limited. In this study we examined the prevalence of VF and associated major risk factors, using a sample of subjects who underwent vertebral fracture assessment (VFA) performed on 2 dual-energy X-ray absorptiometry (DXA) machines. A total of 1296 subjects aged 40 years and older had a valid VFA report and DXA information available, including 254 men and 1042 women. Subjects had a mean age of 70 years, 805 (62%) had prior fractures, mean spine T-score was − 1.4 and mean total hip T-scores was − 1.2, while mean FRAX scores were 15.4% and 4.8% for major osteoporotic fracture and hip fracture, respectively. Although 95 (7%) had a known VF prior to scanning, 283 (22%) patients had at least 1 VF on their scan: 161 had 1, 61 had 2, and 61 had 3 or more. The prevalence of VF increased with age from 11.5% in those aged 40–49 years to > 33% among those aged ≥ 80 years. Both men and women with VF had significantly lower BMD at each measured site, and significantly higher FRAX scores, P < 0.01. These data suggest VF are common in high risk populations, particularly older men and women with low BMD, previous fractures, and at high risk of fracture. Urgent attention is needed to examine effective ways to identify those at risk and to reduce the burden of VF.

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Appropriateness of referrals to a tertiary referral centre for bone mineral density testing

Cited by 9 publications

References 24 publications

Utility of Osteoporosis Self-Assessment Tool as a Screening Tool for Osteoporosis in Irish Men and Women: Results of the DXA-HIP Project

Utility of Osteoporosis Self-Assessment Tool as a Screening Tool for Osteoporosis in Irish Men and Women: Results of the DXA-HIP Project

Acceptability and Feasibility of an Evidence-Based Requisition for Bone Mineral Density Testing in Clinical Practice

Vertebral Fractures in Ireland: A Sub-analysis of the DXA HIP Project

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