A new study of nearly 51, 000 women has found that many patients who should be screened for osteoporosis are not…and some of those who do get screened shouldn’t be. The study, published online in the Journal of General Internal Medicine, comes from the University of California Davis Health System.
Osteoporosis Screening Is Rather Random
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The researchers “found that screening rates increased sharply among women at age 50, despite guidelines suggesting screening at age 65 unless risk factors are present. The presence of risk factors only had a modest influence on screening decisions.”
Anna Lee Amarnath, M.D. “assessed the electronic health records of nearly 51, 000 women who were between the ages of 40 and 85 and received health care in the Sacramento area. Her evaluation included osteoporosis risk factors and whether or not the women received a dual-energy X-ray absorptiometry (DXA), which measures bone mineral density.”
“Over a seven-year period, more than 42% of eligible women between the ages of 65 and 74 years were not screened, nor were nearly 57% of those older than 75, despite the favorable cost-effectiveness of screening in these age groups. In turn, nearly 46% of low-risk women between the ages of 50 and 59 were screened, as were 59% of those aged 60 to 64 years without risk factors.”
“DXA screening was underused in women at increased fracture risk, including women aged 65 years and older. Meanwhile, it was common among women at low fracture risk, such as younger women without osteoporosis risk factors, ” Dr. Amarnath said in the May 19, 2015 news release.
Dr. Amarnath and her colleagues indicate that “Doctors tend to think about age-related bone loss when women enter menopause around age 50, triggering consideration of DXA without also considering overall facture risk.”
Senior author Joshua Fenton, M.D., M.P.H. noted, “Health systems should invest in developing electronic health records systems that prompt providers at the point-of-care when screening is needed and when it can be postponed.” Dr. Fenton is a UC Davis associate professor of family and community medicine.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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