Osteoporosis Screening: Factors Associated with Bone Mineral Density Testing of Older Women

Abstract

BACKGROUND: Osteoporosis is a major public health problem. Guidelines recommend osteoporosis screening, primarily with bone mineral density (BMD) testing, of all women aged > or =65 and younger women at increased risk. However, BMD testing is underused, and osteoporosis screening practices are not in compliance with guidelines. METHODS: This was a retrospective cohort study of 809 women patients > or =65 years. The proportion of patients having evidence of BMD testing and factors associated with BMD testing were evaluated. RESULTS: The overall proportion of patients having evidence of BMD testing was 42.9%. A higher proportion of patients from the gynecology practice (72%) had evidence of BMD testing compared with family medicine (42%), general internal medicine (36%), and the Veterans Administration practice (30%) (p < 0.0001). The proportion of patients with evidence of BMD testing was higher in patients seen by faculty (48%) than in patients seen by midlevel providers (35%) or residents (21%) (p < 0.0001) and was higher in patients of female providers (54%) than in patients of male providers (31%) (p < 0.0001). Negative associations with BMD testing were seen with increasing age and numbers of medications (p < 0.0001 and p < 0.05, respectively). The numbers of visits and numbers of total and unique ICD-9 codes were each negatively associated with BMD testing (p < 0.05, p < 0.005, and p < 0.05, respectively). In patients with commercial insurance, 48% had evidence of BMD testing vs. 25% in the rest of the subjects (p < 0.0001). The proportion of patients with evidence of BMD testing also varied by body mass index (BMI). CONCLUSIONS: Consideration of factors associated with BMD testing may be useful in developing interventions to increase osteoporosis screening rates.