Screening for Osteoporosis in Postmenopausal Women: Adherence to the 2002 USPSTF Guidelines. Patton, E, Fischer, H. Beth Israel Medical Center, Division of Rheumatology, New York, NY.
Background and Objectives: Osteoporosis is a major public health problem in the United States affecting ten million Americans with about 34 million at high risk secondary to osteopenia. As the elderly population continues to grow, the incidence of osteoporosis, and ultimately its complications, primarily fractures, will continue to rise as well. Half of all postmenopausal females will sustain at least one osteoporotic related fracture in a lifetime, with at least 90% of hip and spine fractures among elderly directly attributable to osteoporosis. In 2002, the USPSTF published guidelines for osteoporosis screening in postmenopausal females. These guidelines recommend screening for all females over the age of 65, and those 60-65 years of age with a body mass less than 70 kilograms. The objective of this study is to assess the adherence to these screening guidelines in an urban outpatient radiology center. Experimental Design: All patients registered for a DEXA scan for the evaluation of bone density at the Department of Radiology at the Phillips Ambulatory Care Center (PACC) of Beth Israel Medical Center in New York City over a two-month period, were eligible to participate. Participants completed an anonymous questionnaire to assess current age, weight, gender, and age at first DEXA scan. Completed surveys were then analyzed as a surrogate assessment of referral practices for osteoporosis screening. Results: Thirty percent (209/643) of patients registered for DEXA scans over the two month study period at PACC completed the questionnaires, 181 females, 25 males, ranging in age from 18-87 years. Nineteen percent (35/181) of the females screened were less than 50 years of age, 40%(74/181) were between the age of 50-59 years, 18%(32/181) between the age of 60-65 years, and 19%(36/181) were greater than 65 years of age. Fifty-four percent of those screened reported current DEXA scan as first screening for osteoporosis, compared to 46% who had been screened in the past. Of those reporting first DEXA, 22% (22/98) were less than 50 years of age, 42%(42/98) were 50-59 years, 15%(15/98) were 60-65 years of age, and 19%(19/98) were greater than 65 years of age. Of those reporting current first DEXA scan, 52%(51/98) were less than 70 kilograms, of which 75%(38/51) were less than 60 years of age, compared to 48%(47/98) greater than 70 kilograms, of which 55%(26/47) were less than 60 years of age. Twenty percent (19/98) of those reporting first DEXA scan were greater than 65 years of age. Conclusions: There is an overutilization of DEXA scans for osteoporosis screening in females under the age of 60. This study also highlights the underutilization of screening for osteoporosis in the high-risk group of females greater than 65 years of age, a group that has been shown in previous studies to benefit from the treatment of osteoporosis to decrease the risk of fractures.
Disclosure Information:
Faculty Member's Name: Erin P. Patton, MD, MPH
I have no relationships to disclose.
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