Factors Associated with Osteoporosis Screening and Recommendations for Osteoporosis Screening in Older Adults
Osteoporosis screening rates are low, and it is unclear which patient factors are associated with screening and physician recommendations for screening.
To identify patient characteristics associated with osteoporosis screening recommendations and receipt of screening in older adults.
Cross-sectional mailed survey.
Women and men ≥60 years old living in or near western Pennsylvania.
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.
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.
Individuals with several known osteoporosis risk factors are not being sufficiently targeted for screening.
- U.S. Department of Health and Human Services. Bone health and osteoporosis: a report of the surgeon general. Rockville, MD: U.S. Department of Health and Human Services, Office of the Surgeon General; 2004.
- Looker AC, Orwoll ES, Johnston CC Jr., et al. Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res. 1997; 12: 1761–8. CrossRef
- Burge R, Dawson-Hughes B, Solomon DH, et al. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res. 2007; 22: 465–75. CrossRef
- Nelson HD, Helfand M, Woolf SH, Allan JD. Screening for postmenopausal osteoporosis: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2002; 137: 529–41.
- Nguyen TV, Eisman JA, Kelly PJ, Sambrook PN. Risk factors for osteoporotic fractures in elderly men. Am J Epidemiol. 1996; 144: 255–63.
- Huddleston JM, Whitford KJ. Medical care of elderly patients with hip fractures. Mayo Clin Proc. 2001; 76: 295–8. CrossRef
- Braithwaite RS, Col NF, Wong JB. Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc. 2003; 51: 364–70. CrossRef
- Nevitt MC, Ettinger B, Black DM, et al. The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med. 1998; 128: 793–800.
- Oleksik A, Lips P, Dawson A, et al. Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. J Bone Miner Res. 2000; 15: 1384–92. CrossRef
- Cummings SR, Nevitt MC, Browner WS, et al. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med. 1995; 332: 767–73. CrossRef
- Kanis JA on behalf of the World Health Organization Scientific Group. Assessment of Osteoporosis at the Primary Health Care Level. 2008 Technical Report. University of Sheffield, UK: WHO Collaborating Center; 2008.
- Screening for osteoporosis in postmenopausal women: recommendations and rationale. Ann Intern Med. 2002;137:526–8.
- The National Osteoporosis Foundation (NOF). Clinician’s Guide to prevention and treatment of osteoporosis. Washington, DC: National Osteoporosis Foundation; 2008.
- Qaseem A, Snow V, Shekelle P, et al. Screening for osteoporosis in men: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2008; 148: 680–4.
- Kiebzak GM, Beinart GA, Perser K, et al. Undertreatment of osteoporosis in men with hip fracture. Arch Intern Med. 2002; 162: 2217–22. CrossRef
- Morris CA, Cabral D, Cheng H, et al. Patterns of bone mineral density testing: current guidelines, testing rates, and interventions. J Gen Intern Med. 2004; 19: 783–90. CrossRef
- Gehlbach SH, Fournier M, Bigelow C. Recognition of osteoporosis by primary care physicians. Am J Public Health. 2002; 92: 271–3. CrossRef
- Solomon DH, Brookhart MA, Gandhi TK, et al. Adherence with osteoporosis practice guidelines: a multilevel analysis of patient, physician, and practice setting characteristics. Am J Med. 2004; 117: 919–24. CrossRef
- Curtis JR, Westfall AO, Allison JJ, et al. Longitudinal patterns in the prevention of osteoporosis in glucocorticoid-treated patients. Arthritis Rheum. 2005; 52: 2485–94. CrossRef
- Shah SK, Gecys GT. Prednisone-induced osteoporosis: an overlooked and undertreated adverse effect. J Am Osteopath Assoc. 2006; 106: 653–7.
- Morris CA, Cheng H, Cabral D, Solomon DH. Predictors of screening and treatment of osteoporosis: a structural review of the literature. Endocrinologist. 2004; 14: 70–5. CrossRef
- Miller RG, Ashar BH, Cohen J, et al. Disparities in osteoporosis screening between at-risk African-American and white women. J Gen Intern Med. 2005; 20: 847–51. CrossRef
- Solomon DH, Morris C, Cheng H, et al. Medication use patterns for osteoporosis: an assessment of guidelines, treatment rates, and quality improvement interventions. Mayo Clin Proc. 2005; 80: 194–202. CrossRef
- Marci CD, Anderson WB, Viechnicki MB, Greenspan SL. Bone mineral densitometry substantially influences health-related behaviors of postmenopausal women. Calcif Tissue Int. 2000; 66: 113–8. CrossRef
- Fitt NS, Mitchell SL, Cranney A, et al. Influence of bone densitometry results on the treatment of osteoporosis. CMAJ. 2001; 164: 777–81.
- Solomon DH, Katz JN, Finkelstein JS, et al. Osteoporosis improvement: a large-scale randomized controlled trial of patient and primary care physician education. J Bone Miner Res. 2007; 22: 1808–15. CrossRef
- van Staa TP, Leufkens HG, Abenhaim L, Zhang B, Cooper C. Oral corticosteroids and fracture risk: relationship to daily and cumulative doses. Rheumatology(Oxford). 2000; 39: 1383–9. CrossRef
- Factors Associated with Osteoporosis Screening and Recommendations for Osteoporosis Screening in Older Adults
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Journal of General Internal Medicine
Volume 24, Issue 5 , pp 585-591
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- 1. School of Medicine, Department of Medicine, Division of General Internal Medicine, Section of Decision Sciences and Clinical Systems Modeling, University of Pittsburgh, Pittsburgh, PA, USA
- 3. University of Pittsburgh, 200 Meyran Ave., Suite 200, Pittsburgh, PA, 15213, USA
- 2. School of Medicine, Department of Medicine, Division of Endocrinology and Metabolism and Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA, USA