INCONSISTENT APPLICATION OF DIAGNOSTIC CRITERIA LEADING TO UNDERTREATMENT OF OSTEOPOROSIS IN POSTMENOPAUSAL WOMEN.

Background Although the incidence of hip and vertebral fractures due to osteoporosis surpasses the incidence of breast cancer, stroke, and myocardial infarction in postmenopausal women, the reported screening rates for osteoporosis with DEXA scan have been less than half of those reported for breast cancer screening. The low rate of osteoporosis screening occurs despite reimbursement by Medicare. In this report, we examine the association of Dexascan T-scores with osteoporosis treatment. Methods The Better Osteoporosis Knowledge and Screening Study (BONES) is a quality improvement initiative that includes 13 residency clinics. We report results from the first six sites. Enrolled women were at least 67 years of age (to ensure Medicare coverage over the last 2 years) with at least one prior visit to the participating clinic. Participants answered a 77-item survey and viewed an educational video on osteoporosis. Baseline chart reviews of all participating patients were done to document prior screening. Descriptive statistics were compiled. Bivariate analyses were performed regarding actual osteoporosis treatment with bisphosphonates, PTH, or calcitonin as the outcome. Results In a preliminary analysis of 122 charts, 31 women had the diagnosis of osteoporosis, yet only 23 had received a DEXA scan. Only 15 met diagnostic criteria by DEXA scan. Regarding treatment, of the 28 women who had been prescribed osteoporosis medications, 10 had T scores ≤ −2.5; 3 had T scores −2.0 to −2.4; 4 had T scores −1.9 to −1.5, and 1 had a T score ≤ −1.0. The remaining 10 (36%) receiving treatment had no evidence of DEXA scan, and only 4 of the 10 had a diagnosis of osteoporosis documented in the chart. Age, income, prior education, comorbidities, and history of fractures did not significantly predict diagnosis or treatment or in any T score group. The only statistically significant associations of treatment were white race (p = .05) and prior conversation about osteoporosis with their physician (p = .005). Conclusion Our preliminary data suggest that physicians are applying and interpreting diagnostic criteria for osteoporosis inconsistently and basing decisions to treat osteoporosis on factors that are not readily apparent or documented.