Background Bone densitometry examination with DXA is an important tool in identifying patients with low bone densities and high fracture risk. Osteoporotic fractures account for more than 1.2 million fractures, at the cost of $20 billion yearly. Mortality from hip fracture is 25% per year. Despite this, many women do not get screened. One barrier might be that physicians do not order tests in patients with comorbid conditions. We examined the association of comorbid illnesses and the rate of DXA screening in an outpatient setting.
Methods This study was a cohort prospective quality improvement project to enhance adherence to osteoporosis screening guidelines in eligible or at-risk patients. This was a collaborative multicenter study consisting of six different outpatient clinic sites. Female patients age 65 or older were recruited from each clinic site. We examined the relationship of comorbid illnesses individually and as a comorbid score to the rate of osteoporosis screening.
Results We presented preliminary results of 137 patient questionnaire surveys with a mean age of 75 years (age 65-98). Of 121 charts reviewed, 44% had DXA screening. Using chi-square test, we found positive correlation between DXA screening and a diagnosis of cancer (p = .03). We also found a positive association between DXA screening and thyroid disease (p = .07). A diagnosis of DM had a negative association with DXA screening (p = .01). No association was found between other chronic disease conditions and DXA screening. The positive association of cancer and thyroid disease was also present using logistic regression analysis (OR = 3.02, p = .05 and OR = 3.2, p = .03). The negative correlation of DM and DXA screening was also present with logistic regression analysis (OR = 0.3, p = .02). The combined comorbid score was not associated with DXA scan performance.
Conclusion Based on preliminary data, patients with cancer and thyroid disease appear to have an increased rate of DXA screening. Physician awareness of detrimental effects of aromatase inhibitor therapy and of oversupplementation of l-thyroxine on bone mineral density might explain these findings. Diabetic patients, on the other hand, were screened less. This phenomenon might be attributable to the association of diabetes and increased severity of illness or physicians' perception of competing medical interests. To maximize osteoporosis screening further investigation of this result is warranted.
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