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Why Don’t More Physicians Order Bone Scans for Postmenopausal Patients?

An article recently published online by Osteoporosis International confirms findings of earlier surveys that many physicians seldom order  bone mineral density scans for postmenopausal patients; this despite evidence that the tool is useful in diagnosing osteoporosis. Douglas P. Kiel, M.D., M.P.H., director of medical research in the Research and Training Institute of Hebrew Rehabilitation Center for Aged, was among the report’s authors. Beyond confirming that many physicians resist densitometry technology, the study sought to discover predictors of low utilization that would go far in understanding the reason why this is the case.

Bone densitometry is designed to measure bone mineral density (BMD), acknowledged by several studies to be a major predictor of fracture risk in postmenopausal women. Fracture is associated with Osteoporosis, a condition that causes loss of bone mass. It is primarily associated with aging, and women are most at risk.

Each year, more than 250,000 individuals aged 65 or older suffer hip fractures as a result of osteoporosis. Given the evidence that measuring bone density increases the likelihood that osteoporosis will be identified, patients treated and fracture risk reduced, why wouldn’t a physician order the test?

Study investigators surveyed 494 primary care physicians in New England. At the end of the study, several characteristics emerged defining a physician most likely to order a bone densitometry scan for his or her postmenopausal patient. According to survey results, if a woman were interested in finding one of these physicians she should look for the following:

  • An obstetrician-gynecologist versus a general internist or family physician;
  • A physician with a suburban practice versus an urban or rural practice;
  • A physician who spends over 50% of his or her time in patient care;
  • A physician whose patients include a large number of postmenopausal women; and
  • A physician who believes that calcium and vitamin D alone are not adequate treatment for osteoporosis, and bone densitometry measurement is necessary as a basis for treatment.

The study’s authors conclude that the key to getting physicians to order bone densitometry scans lies in education of both physician and patient. The article states, “the use of carefully crafted messages in smaller educational settings has been an important means of changing physicians’ testing practices.” In addition, if patients are also educated about the benefit of BMD measurement, they will ask for the scans more often.

"It is surprising that more physicians are not ordering bone mineral density testing, especially since insurance covers the test and it has even been recommended by the US Preventive Services Task Force,” says Dr. Kiel. “I guess it is a matter of educating physicians and patients alike.”