Background Osteoporosis is a disease that is characterized by low bone mass and structural deterioration of bone tissue. The result is bone fragility and an increased susceptibility to fractures, especially of the hip, spine, and wrist. Bone densitometry examination with DXA scanning is an important tool in identification of patients at risk of fractures. In this study, we examined how the presence of clinical risk factors for individual patients affected their rate of bone mineral density testing.
Methods This study is a cohort prospective quality improvement study to enhance adherence to osteoporosis screening guidelines in eligible/at-risk patients. This is a collaborative multi-institutional study consisting of 13 different sites. Female patients, age 65 or older as of June 1, 2004, who have a regular doctor at the clinic are recruited from each clinic site. One hundred thirty-seven patients completed the patient questionnaire and viewed a PowerPoint presentation about osteoporosis. One hundred twenty-one patient charts were reviewed for evidence of prior osteoporosis screening. The data on clinical risk factors were collected from the patient questionnaire and the chart review. These factors included weight, race, history of fracture, family history of osteoporosis, smoking, and chronic use of steroids. Descriptive data were compiled, and both bivariate and regression analyses were performed.
Results We present the preliminary results from the first 137 patient surveys and 6 clinical sites. The mean age of participants was 75 years (age 65-98). Of 121 charts reviewed, 53 patients (44%) had DXA screening done. We found an association between screening and low patient weight. No significant association was found with performance of dexascan and any other clinical risk factor in this preliminary report. The associaton of low weight and DXA screening was still shown while controlling for demographic data and the other risk factors (OR = 8.469 [report 95% CI instead of p value]and p = .008).
Conclusion Although this report represents a preliminary analysis, physicians seem to be sensitive to screening for osteoporosis in low-weight women. Increased physician awareness of other risk factors seems to be needed as a trigger for more aggressive screening practices.
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