Physician characteristics associated with the use of bone densitometry

Abstract

To determine physician characteristics associated with the use of bone densitometry (BD), we conducted a cross-sectional survey of primary care practitioners in an urban community hospital. Participants were internists, geriatricians, and family practitioners. Seventy-two percent of the physicians never used BD. There was no association between physician or practice characteristics and BD use. Bone densitometry users were more likely than nonusers to treat their patients with osteoporosis or at risk of developing it. Self-reported barriers to use included cost, unfamiliarity with guidelines, uncertainty with clinical applicability, minimal impact on treatment decisions, and availability. In conclusion, although it has been shown that osteoporotic women who are aware of their BD results are more likely to accept treatment, further attention should be paid to primary care practitioners' attitudes, knowledge, and behavior regarding the use of BD in the management of osteoporosis. steoporosis is believed to result in at least 1.3 million fractures in the United States each year. 1 These fractures result in significant morbidity and mortality in the fastest growing segment of our population, the elderly. Because of this, osteoporosis is a significant health concern that may eventually cost the United States between $4 billion and $60 billion a year. 2,3 Efforts aimed at maintaining bone mass are considered crucial in decreasing the risk of fractures. [3][4][5][6] Several studies have shown that for 1 SD decrement in bone mass, fracture risk increases as much as 50% to 100%. 4 Recently, the efficacy of the bisphosphonate alendronate was demonstrated by documenting a 48% reduction in vertebral fracture rates in conjunction with a 9% increase in bone density. 7 The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial also demonstrated as much as a 5% increase in bone mineral density with hormone replacement therapy. 8 Bone mass can now be measured in a safe, reliable and accurate manner using bone densitometry (BD), especially with the development of dualenergy x-ray absorptiometry (DEXA). 9 Bone densitometry may have an expanded role in the management of patients with osteoporosis, especially given the multiple options for treatment. [10][11][12] Because screening all perimenopausal women is costly, several experts have published selective screening practice guidelines for women at high risk of osteoporosis: women with estrogen deficiency considering replacement therapy, patients with radiographic abnormalities suggesting osteoporosis, patients on longterm glucocorticoid or anticonvulsant therapy, and patients with primary hyperparathyroidism. 9,13-18 However, there is no evidence linking BD use with reduced fracture incidence.Rubin and Cummings reported that women's knowledge of their BD results influenced their decision to accept therapy for osteoporosis. 19 It has not previously been reported whether the physician's knowledge of patients' BD results influences treatment recommendations.Given the uncertain ut...

Use of Bone Densitometry by Ontario Family Physicians

“…As would be expected, physicians who indicated that their use of densitometry was limited ordered significantly fewer bone density tests than their colleagues with 'unlimited access'. The only other published study on physician use of densitometry is a survey of physicians at a single community hospital in Rochester, New York in 1994 [14]. In that study, densitometry was used by only 28% of respondents, with only 5% ordering more than five tests annually, while in our study, 96% of respondents used densitometry, most on a regular basis.…”

Increased serum osteopontin is a risk factor for osteoporosis in menopausal women

“…At any given BMD, fracture risk is higher in older individuals, indicating quality factors in addition to BMD contribute to bone fragility and increased fracture risk. BMD represented by T-score classification was used as the end outcome in this series, but BMD only provides information regarding the mineral quantity in bones, which is only one component of bone strength and cannot fully account for menopausal fracture risk [42][43][44][45][46][47]. In this study, we lack data regarding the influence of OPN on bone quality.…”

Disparities in osteoporosis screening between at-risk African-American and white women

“…Although the screening referral rate of 43% for our entire study population was suboptimal, it was higher than rates in previous studies, perhaps because of the academic nature of the clinics (both sites had residency training programs). In other studies of at‐risk women, only 12% of women ≥65 years and 34% of postmenopausal women with a fracture history received DXA screening, 16 fewer than 30% of primary care physicians had ever ordered a DXA, 17 and documentation by family practice physicians of osteoporosis discussion occurred in only 35% of at‐risk women 18 . Barriers to physician screening may include limited knowledge of guidelines, cost and availability of testing facilities, and the belief that results would not affect treatment decisions 22 …”

“…Although most preventive care occurs with the primary care physician, studies suggest that only a small proportion of patients at risk for osteoporosis are currently being screened 16–18 . Concern also exists that misperceptions about the importance and prevalence of osteoporosis in the African‐American community may lead to even lower screening rates in this population 2,19,20 .…”

“…15 Although most preventive care occurs with the primary care physician, studies suggest that only a small proportion of patients at risk for osteoporosis are currently being screened. [16][17][18] Concern also exists that misperceptions about the importance and prevalence of osteoporosis in the African-American community may lead to even lower screening rates in this population. 2,19,20 Indeed, NORA documented a high prevalence of previously undiagnosed disease among postmenopausal African-American women, finding that 32% had osteopenia and 4% had osteoporosis.…”