Osteoporosis International

, Volume 27, Issue 7, pp 2311–2316 | Cite as

Has Choosing Wisely® affected rates of dual-energy X-ray absorptiometry use?

  • E. C. Lasser
  • E. R. Pfoh
  • H. Y. Chang
  • K. S. Chan
  • J. C. Bailey
  • H. Kharrazi
  • J. P. Weiner
  • S. M. Dy
Original Article



Reducing overuse of tests such as dual-energy X-ray absorptiometry (DXA) scans in younger women is an important quality issue. We evaluated trends in DXA ordering before and after Choosing Wisely recommendations were released. We found no significant difference in ordering trends suggesting that other initiatives are needed to change behavior.


Reducing overuse of tests such as dual-energy X-ray absorptiometry (DXA) scans in younger women is an important quality issue, but trends in care are difficult to change. We evaluated (1) trends in DXA ordering before and after the Choosing Wisely recommendation release and (2) patterns of key characteristics that indicate a potentially appropriate DXA scan order.


We performed a retrospective longitudinal analysis of electronic health record data at a multi-specialty, ambulatory care network of 34 practices across Maryland and Washington, DC. Since the Choosing Wisely DXA recommendation was released April 2012, the study periods were April–December 2011 (pre-initiative) and April–December 2012 (post-initiative). Women between 50 and 64 years with primary care encounters, and primary care providers who saw ten or more women in the study population in both pre and post periods were included.


For 42,320 eligible patients, the mean provider ordering rate was 2.6 % pre-initiative and 2.0 % post-initiative; there was no significant difference in trend over time. Over 70 % of the population had no characteristics associated with potentially appropriate DXA ordering. Low body mass index, current smoker status, and osteopenia were the most common characteristics indicating potentially appropriate DXA orders. Patients with any of these three characteristics had DXA ordering rates between 3–20 %.


The trend in provider ordering rates of DXA scans did not decrease after the release of the DXA Choosing Wisely recommendation. Targeted initiatives addressing providers with high ordering rates will be needed to change behavior.


Bone density Choosing Wisely DXA General medicine Primary care 



All authors contributed to the conception and/or design of this study. ECL, SMD, JPW, and JCB contributed to the acquisition of data. SMD, HYC, and ECL contributed to the analysis of data, and all authors contributed to the interpretation of data. ECL, SDY, and ERP drafted the manuscript, and all authors critically revised it for important intellectual content and approved the final version to be submitted. HYC had full access to the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis.

Compliance with ethical standards

Conflicts of interest



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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2016

Authors and Affiliations

  • E. C. Lasser
    • 1
    • 4
  • E. R. Pfoh
    • 1
    • 2
  • H. Y. Chang
    • 1
  • K. S. Chan
    • 1
  • J. C. Bailey
    • 3
  • H. Kharrazi
    • 1
    • 4
  • J. P. Weiner
    • 1
    • 4
  • S. M. Dy
    • 1
  1. 1.Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.Division of General Internal MedicineJohns Hopkins Medical SchoolBaltimoreUSA
  3. 3.Johns Hopkins Community PhysiciansBaltimoreUSA
  4. 4.Johns Hopkins Center for Population Health ITBaltimoreUSA

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