Adherence of academic geriatric practitioners to osteoporosis screening guidelines
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
To examine the bone mineral density (BMD) testing habits of geriatricians and geriatric fellows at the University of Connecticut fellowship training program to evaluate their adherence screening guidelines.
Retrospective chart review.
University based academic geriatric practice in Farmington, CT.
Chart review of two hundred female patients over age 65 under care of seven faculty geriatricians and eight geriatric fellows in training.
Data collected included BMD testing status, patient’s osteoporosis risk factors and functional status.
Physicians ordered BMD tests in 151 (76%) patients; 128 (64%) had a bone mineral density test within three years. A personal history of fracture was the only osteoporosis risk factor that correlated to higher rates of osteoporosis testing. Physicians were more likely to order BMD screening in younger patients (92% in 65–74 vs. 74% in ages 85+, P=.031), patients independent in activities of daily living (72% vs. 32, P=.002), and patients without dementia (70% vs.37%, p=.007). BMD testing results found 82% with osteopenia or osteoporosis.
A geriatric group that is highly attuned to bone health demonstrated more optimal adherence to OP testing guidelines for all “at-risk” older women and better than reported previously. Functional status more strongly predicted BMD testing than osteoporosis risk factors. This study suggests that with improved physician education and familiarity with the disease, high rates of BMD testing for earlier identification of geriatric patients at risk for osteoporosis are achievable.
- Melton LJ, Lane AW, Cooper C, Eastell R, O’Fallon WM, Riggs BL (1993) “Prevalence and incidence of vertebral deformities.” Osteoporosis Int 3:113–119 CrossRef
- Burger H, Van Daele PL, Grashuis K, Hofman A, Grobbee DE, Schutte HE, Birkenhager JC, Pols HA (1997) “Vertebral deformities and functional impairment in men and women.” JBMR 12:152–157
- Kanis JA, Johnell O, Oden A, Dawson A, De Laet C, Jonsson B (2001) “Ten year probabilities of osteoporotic fracture according to BMD and diagnostic thresholds.” Osteoporosis Int 12:989–995 CrossRef
- Fulton JP (1999) “New guidelines for the prevention and treatment of osteoporosis. National Osteoporosis Foundation.” Med Health 82:110
- National Osteoporosis Foundation. “Physician’s guide to prevention and treatment of osteoporosis.” (Washington, DC) 2003
- “Assessment of fracture risk and its application to screening for postmenopausal osteoporosis.” World Health Organization. WHO Technical Report Series 843. (Geneva) 1994
- Kern LM, Powe NR, Levine MA, Fitzpatrick AL, Harris TB, Robbins J, Fried LP et al (2005) “Association between screening for osteoporosis and the incidence of hip fracture.” Ann Intern Med 142:173–181
- Cummings SR, Black DM, Thompson DE et al (1998) “Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial.” JAMA 280:2077–2082 CrossRef
- Reginster J, Minne HW, Sorensen OH et al (2000) “Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. (VERT) Study Group.” Osteoporosis Int 11:83–91 CrossRef
- Chesnut CH 3rd, Silverman S, Andriano K, Genant H, Gimona A, Harris S, Kiel D, LeBoff M, Maricic M, Miller P, Moniz C, Peacock M, Richardson P, Watts N, Baylink D et al (2000) “A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the prevent recurrence of osteoporotic fractures study. PROOF Study Group.” Am J Med 109:267–276 CrossRef
- Delmas PD, Bjarnason NH, Mitlak BH et al (1997) “Effects of Raloxifene on bone mineral density, serum cholesterol concentrations, and uterine endometrium in postmenopausal women.” N Engl J Med 337:1641–1647 CrossRef
- Neer RM, Arnaud CD, Zanchetta JR et al (2001) “Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis.” N Engl J Med 344:1434–1441 CrossRef
- Lewiecki EM, Watts NB, McClung MR et al (2004) “Official positions of the International Society for Clinical Densitometry.” J Clin Endocrinol Metab 89:3651–3655 CrossRef
- US Preventive Services Task Force (2002) “Screening for osteoporosis in postmenopausal women: recommendations and rationale.” Ann Intern Med 137:526–528
- “Bone Health and Osteoporosis: A Report of the Surgeon General.” (2004) Available online http://www.surgeongeneral.gov/library/bonehealth Accessed Dec. 11, 2005
- Siris ES, Miller PD, Barrett-Connor E et al (2001) “Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment.” JAMA 286:2815–2822 CrossRef
- Solomon DH, Connelly MT, Rosen CJ et al (2003) “Factors related to the use of bone densitometry: survey responses of 494 primary care physicians in New England.” Osteoporosis Int 14:123–129
- Sheehan J, Mohamed F, Reilly M et al (2000) “Secondary prevention following fractured neck of femur: a survey of orthopaedic surgeons practice.” Ir Med J 93:105–107
- Hajcsar EE, Hawker G, Bogoch ER (2000) “Investigation and treatment of osteoporosis in patients with fragility fractures.” Can Med Assoc J 163:819–822
- Solomon DH, Brookhart MA, Gandhi TK et al (2004) “Adherence with osteoporosis practice guidelines: A multilevel analysis of patient, physician, and practice setting characteristics.” Am J Med 117:919–924 CrossRef
- Morris CA, Cabral D, Cheng H et al (2004) “Patterns of bone mineral density testing: current guidelines, testing rates, and interventions.” J Gen Intern Med 19:810–811 CrossRef
- Cummings SR, Browner WS, Grady D et al (eds) (2001) Designing clinical research: an epidemiologic approach, 2nd ed. Lippincott, Williams & Wilkins. (Philadelphia)
- Ingelfinger JH, Ware F, Mosteller LT (1994) Biostatistics in Clinical Medicine (3rd edn) McGraw Hill (New York)
- Cassidy LD, Marsh GM, Holleran MK et al (2002) “Methodology to improve data quality from chart review in the managed care setting.” Am J Managed Care 8:787–793
- Gilbert EH, Lowenstein SR, Koziol-McLain J et al (1996) “Chart reviews in emergency medicine: Where are the methods?” Annals Emer Med 27:305–308
- Peabody JW, Luck J, Glassman P (2000) “Comparison of vignettes, standardized patients and chart abstraction: a prospective validation study of 3 methods for measuring quality.” JAMA 283:1715–1722 CrossRef
- Yawn BP, Wollan P (2005) “Interrater reliability: Completing the methods description in medical records review studies.” AM J Epidemiol 161:974–977 CrossRef
- Centers for Disease Control and Prevention. Health, United States, (2005) Atlanta (GA): Department of Health and Human Services (US). CDC
- Centers for Disease Control and Prevention (2002) Behavioral Risk Factor Surveillance System Survey Data BRFSS. Atlanta (GA): Department of Health and Human Services (US). CDC
- Probstfield JL, Weiner DH, Shrikant I et al (1989) The studies of left ventricular dysfunction (SOLVD) experience with a placebo run-in phase. Control Clin Trials 10:334
- Brookhart MA, Solomon DH, Wang P et al (2006) “Explained variation in a model of therapeutic decision making is partitioned across patient, physician and clinic factors.” J Clin Epi 59:18–25 CrossRef
- Breeze E, Clarke R, Shipley MJ et al (2006) Cause-specific mortality in old age in relation to body mass index in middle age and old age: follow up of the Whitehall cohort of male civil servants. Int J Epidemiol 35169–178 CrossRef
- Sergi G, Perissinotto E, Pisent C et al (2005) ILSA Working Group. An adequate threshold for body mass index to detect underweight condidtion in elderly persons: the Italian Longitudinal Study on Aging (ILSA). J Gerontol Biol Sci Med 60:866–871
- Sato Y, Kanoko T, Satoh K (2005) “The prevention of hip fracture with risedronate and ergocalciferol plus calcium supplementation in elderly women with Alzheimer disease: a randomized controlled trial.” Arch Intern Med 165:1737–1742
- Levy RL (1985) Social support and compliance: Update. J Hypertens 3:S45–S49
- Adherence of academic geriatric practitioners to osteoporosis screening guidelines
Volume 18, Issue 2 , pp 177-183
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Bone mineral density (BMD)
- Geriatric practitioner
- Osteoporosis risk factors
- Industry Sectors