New AHRQ Study: Women at Risk for Osteoporosis Often Not Screened

There is both underuse and overuse of screening for osteoporosis among various groups of women, according to a new AHRQ-funded study. Researchers studied more than 50,000 women between the ages of 40 and 85 who received primary care at the University of California Davis Health System clinics from 2006 to 2012. They found underuse of screening among those for whom the U.S. Preventive Services Task Force (USPSTF) recommends screening. The USPSTF recommends examining for osteoporosis with dual-energy X-ray absorptiometry (DXA) screening for women over the age of 65 and for younger women with increased risk. Investigators found that more than 40 percent of eligible women between the ages of 65 and 74 did not receive recommended DXA screening. Meanwhile, about half of women younger than 65 years old without risk factors received a screening. Researchers also found that DXA screening was significantly less common among black women compared with white women, as well as among current smokers. The study and abstract were published in the May 19 issue of theJournal of General Internal Medicine.

2015 May 19. [Epub ahead of print]

Underuse and Overuse of Osteoporosis Screening in a Regional Health System: a Retrospective Cohort Study.

Amarnath AL1, Franks P, Robbins JA, Xing G, Fenton JJ.

Author information

Abstract

BACKGROUND:

The United States Preventive Services Task Force (USPSTF) recommends screening for osteoporosis with dual-energy x-ray absorptiometry (DXA) for women aged ≥ 65 years and younger women with increased risk. "Choosing Wisely" initiatives advise avoiding DXA screening in women younger than 65 years without osteoporosis risk factors.

OBJECTIVE:

We aimed to determine the extent to which DXA screening is used in accordance with USPSTF recommendations within a regional health system.

DESIGN:

This was a retrospective longitudinal cohort study within 13 primary care clinics in the Sacramento, CA region.

PATIENTS:

The study included 50,995 women aged 40-85 years without prior osteoporosis screening, diagnosis, or treatment attending primary care visits from 2006 to 2012, observed for a mean of 4.4 years.

MAIN MEASURES:

We examined incidence of DXA screening. Covariates included age, race/ethnicity, and osteoporosis risk factors (body mass index < 20, glucocorticoid use, secondary osteoporosis, prior high-risk facture, rheumatoid arthritis, alcohol abuse, and current smoking).

KEY RESULTS:

Among previously unscreened women for whom the USPSTF recommends screening, 7-year cumulative incidence of DXA screening was 58.8 % among women aged 60-64 years with ≥ 1 risk factor (95 % CI: 51.9-65.8 %), 57.8 % for women aged 65-74 years (95 % CI: 55.6-60.0 %), and 42.7 % for women aged ≥ 75 years (95 % CI: 38.7-46.7 %). Among women for whom the USPSTF does not recommend screening, 7-year cumulative incidence was 45.5 % among women aged 50-59 years (95 % CI 44.1-46.9 %) and 58.6 % among women aged 60-64 years without risk factors (95 % CI 55.9-61.4 %).

CONCLUSIONS:

DXA screening was underused in women at increased fracture risk, including women aged ≥ 65 years. Meanwhile, DXA screening was common among women at low fracture risk, such as younger women without osteoporosis risk factors. Interventions may be needed to augment the value of population screening for osteoporosis.