Journal of General Internal Medicine

, Volume 33, Issue 10, pp 1796–1804 | Cite as

Metasynthesis of Patient Attitudes Toward Bone Densitometry

  • Aaron T. SeamanEmail author
  • Melissa Steffen
  • Taisha Doo
  • Heather S. Healy
  • Samantha L. Solimeo
Review Paper



Bone densitometry (e.g., dual-energy X-ray absorptiometry or “DXA”) is strongly associated with osteoporosis treatment; however, rates of DXA are low. While studies have demonstrated a continued need for primary care provider education on the role of DXA in preventive care, little is known about the role of patient attitudes toward DXA. This review’s purpose is to synthesize the evidence about the effects of patient perceptions and experiences of DXA on osteoporosis prevention.


A metasynthesis was conducted of English language, peer-reviewed publications, searching relevant databases: MEDLINE, CINAHL, Web of Science Social Science Citation Index, PsycINFO, and Sociological Abstracts. Identified articles’ quality was appraised using the Critical Appraisal Skills Programme (CASP) Qualitative Checklist, and an iterative process of data evaluation, integration, and synthesis was used to develop the findings.


Thirteen articles from ten studies were identified, composing an aggregated sample of 265 people (231 women). Participant attitudes toward screening ranged from receptive to ambivalent to concerned about results. Participants’ understandings of DXA and its role in clinical care were limited. Knowledge of osteoporosis was also partial and influenced by lay sources, the media, and health care providers. Primary care providers strongly influenced participant behavior, especially if participants had a more passive approach to health care. Participants reported less concern about expected barriers of health care access and cost.


Minimal knowledge exists of patient perceptions and experiences of DXA among those who are fracture naïve: Prior research has focused primarily on secondary fracture prevention contexts. Our metasynthesis reveals patients’ significant reliance, given their limited risk appraisal and knowledge, upon primary care providers in decision-making. We urge colleagues to conduct qualitative research on DXA barriers among general primary care population in order to facilitate health care delivery systems better equipped to diagnose and treat patients before their first fracture.


Osteoporosis Preventive care Qualitative research Systematic reviews 



This material is based upon work supported in part by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development. The results of this research were presented by Dr. Solimeo at the Society for Applied Anthropology 2018 Annual Meeting in a presentation entitled, “Understanding the Crisis in Osteoporosis Care through Metasynthesis.”

Funding Information

Dr. Solimeo received support from the Center for Comprehensive Access and Delivery Research and Evaluation, Department of Veterans Affairs, Iowa City VA Health Care System, Iowa City, IA (Award No. CIN 13-412) and VA Health Services Research and Development (Award No. CDA 13-272).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.


The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US government.

Supplementary material

11606_2018_4587_MOESM1_ESM.docx (28 kb)
ESM 1 (DOCX 27.8 kb)


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Copyright information

© Society of General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply) 2018

Authors and Affiliations

  • Aaron T. Seaman
    • 1
    • 2
    Email author
  • Melissa Steffen
    • 1
  • Taisha Doo
    • 3
    • 4
  • Heather S. Healy
    • 5
  • Samantha L. Solimeo
    • 1
    • 2
  1. 1.Department of Veterans Affairs, Center for Comprehensive Access & Delivery Research and Evaluation (CADRE)Iowa City VA Health Care SystemIowa CityUSA
  2. 2.Department of Internal Medicine, Carver College of MedicineUniversity of IowaIowa CityUSA
  3. 3.Carver College of MedicineUniversity of IowaIowa CityUSA
  4. 4.University of Chicago (NorthShore) Family Medicine ResidencyGlenviewUSA
  5. 5.University of Iowa Libraries, Hardin Library for the Health SciencesUniversity of IowaIowa CityUSA

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