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ARS Home » Northeast Area » Boston, Massachusetts » Jean Mayer Human Nutrition Research Center On Aging » Research » Publications at this Location » Publication #161462
Title: FACTORS RELATED TO THE USE OF BONE DENSITOMETRY: SURVEY RESPONSES OF 494 PRIMARY CARE PHYSICIANS IN NEW ENGLAND

Author
item SOLOMON, DANIEL - BRIGHAM AND WOMEN'S HOSPT
item CONNELLY, MAUREEN - HARVARD MEDICAL SCHOOL
item ROSEN, CLIFFORD - MAIN OSTEOPOROSIS CENTER
item DAWSON-HUGHES, BESS - HNRCA
item KIEL, DOUGLAS - HEBREW REHAB CENTER
item GREENSPAN, SUSAN - UNIVERSITY OF PITTSBURGH
item LEIB, EDWARD - UNIVERSITY OF VERMONT
item HOLICK, MICHAEL - BOSTON UNIVERSITY
item MIGUEL, ANTHONY - PROCTER & GAMBLE
item FINKLESTEIN, JOEL - MASS GENERAL HOSPITAL

Submitted to: Osteoporosis International
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 9/3/2002
Publication Date: 3/14/2003
Citation: SOLOMON, D.H., CONNELLY, M.T., ROSEN, C.J., DAWSON-HUGHES, B., KIEL, D.P., GREENSPAN, S.L., LEIB, E.S., HOLICK, M., MIGUEL, A.H., FINKLESTEIN, J.S. FACTORS RELATED TO THE USE OF BONE DENSITOMETRY: SURVEY RESPONSES OF 494 PRIMARY CARE PHYSICIANS IN NEW ENGLAND. OSTEOPOROSIS INTERNATIONAL. 2003. v.14. p.123-129.

Interpretive Summary: Approximately 30% of people over the age of 65 have osteoporosis and 17% of the population over 65 will sustain a fracture during their lifetime. Many patients with osteoporosis are not diagnosed or treated. The objective of this survey is to examine possible reasons for undertreatment of this disease, based on characteristics of primary care physicians within the New England area. Measurement of bone mineral density (BMD) is known to be an important diagnostic tool in the prediction of fractures. In addition, calcium and vitamin D supplements and bone medications have been shown to reduce the risk of fractures. In this survey of 495 responding physicians, 92% agreed that osteoporosis can lead to serious health consequences. However, the respondents reported a very low referral rate for bone density measurement, an average of 10 referrals out of 322 patients seen per month. Furthermore, 25% of those physicians responding indicated that they made less than 4 referrals per month. Despite the high rate of physicians (68%) who feel that bone density measurement is useful for monitoring osteoporosis treatment, 48% are unsure if treatment decisions should be based on bone densitometry results. More than half of the responding physicians feel that patients with osteoporosis do not need to be referred to a specialist, yet 66% feel unsure that most patients with osteoporosis are treated adequately, and 58% are unsure if osteoporosis can be prevented in most patients. With this high rate of uncertainty in the diagnosis and treatment of osteoporosis, educational efforts should be aimed at improving the use of bone density testing and increasing effective treatment options for patients with osteoporosis.

Technical Abstract: Large population-based surveys have shown that approximately 30% of people over age 65 have osteoporosis and that 17% of those over 65 will sustain a fracture during their lifetime. Many people with osteoporosis are not being diagnosed even though effective treatments are available. A cross- sectional survey was conducted of primary care physicians specializing in general/family/internal medicine, & obstetrics-gynecology within the six New England states who had a fax number listed with the American Medical Association. Demographics, practice characteristics, use of bone densitometry, attitudes regarding osteoporosis, bone densitometry, and health maintenance were assessed. Results showed that respondents were more likely to be female, with a mean age of 51; 51% were trained in internal medicine, 25% in general practice/family practice, and 24% in obstetrics/gynecology. The mean number of self-reported bone densitometry referrals monthly was 10 +/-11, and 25% reported that they referred 4 patients or fewer per month. Significant factors associated with referring <4 patients per month were training in internal/general/ family medicine vs. ob/gyn; practice in an urban or rural vs. a suburban setting; <50% of professional time spent in patient care; seeing the lowest proportion of postmenopausal women; belief that calcium and vitamin D adequately treat osteoporosis; and belief that osteoporosis treatment should not be based on bone density results. Potentially modifiable physician beliefs and a number of practice characteristics are associated with low referral rates for bone densitometry. Educational strategies aimed at improved use of bone density testing should consider these factors.