Patterns of bone mineral density testing: current guidelines, testing rates, and interventions

Abstract

Objectives: To identify potential obstacles to bone mineral density (BMD) testing, we performed a structured review of current osteoporosis screening guidelines, studies of BMD testing patterns, and interventions to increase BMD testing.

Design: We searched medline and HealthSTAR from 1992 through 2002 using appropriate search terms. Two authors examined all retrieved articles, and relevant studies were reviewed with a structured data abstraction form.

Measurements and main results: A total of 235 articles were identified, and 51 met criteria for review: 24 practice guidelines, 22 studies of screening patterns, and 5 interventions designed to increase BMD rates. Of the practice guidelines, almost one half (47%) lacked a formal description of how they were developed, and recommendations for populations to screen varied widely. Screening frequencies among at-risk patients were low, ranging from 1% to 47%. Only eight studies assessed factors associated with BMD testing. Female patient gender, glucocorticoid dose, and rheumatologist care were positively associated with BMD testing; female physicians, rheumatologists, and physicians caring for more postmenopausal patients were more likely to test patients. Five articles described interventions to increase BMD testing rates, but only two tested for statistical significance and no firm conclusions can be drawn.

Conclusions: This systematic review identified several possible contributors to suboptimal BMD testing rates. Osteoporosis screening guidelines lack uniformity in their development and content. While some patient and physician characteristics were found to be associated with BMD testing, few articles carefully assessed correlates of testing. Almost no interventions to improve BMD testing to screen for osteoporosis have been rigorously evaluated.

FIGURE 1

Practice Guidelines for Osteoporosis Screening Shading indicates that component discussed in the guideline; X indicates primary patient group(s). *Of fracture or osteoporosis. AACE, American Association of Clinical Endocrinologists; ACR, American College of Rheumatology; RCP, Royal College of Physicians; NOS, National Osteoporosis Society; NOF, National Osteoporosis Foundation; AMDA, American Medical Directors Association; ANCC, Australian National Consensus Conference; USPSTF, United States Preventative Services Task Force; FORE, Foundation for Osteoporosis Research and Education; OSC, Osteoporosis Society of Canada; BMI, body mass index; BMD, bone mineral density.