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Osteoporosis screening and treatment guidelines: are they being followed?

Schnatz, Peter F. DO, FACOG, FACP, NCMP1,2,3,4; Marakovits, Kimberly A. BA1,5; DuBois, Melissa MD1; O'Sullivan, David M. PhD1

doi: 10.1097/gme.0b013e318215101a
Original Articles

Objective: The objective of this study was to examine a cohort of women sent for dual-energy x-ray absorptiometry (DXA) screening to see whether they met the criteria for bone density testing. In addition, we sought to determine whether they were receiving appropriate interventions, based on published guidelines.

Methods: Between January 1, 2007, and March 1, 2009, inclusive, postmenopausal women (age >49 y) who were sent for DXA bone density screening were offered enrollment into the study. Risk factors for osteoporosis, demographic information, and current DXA results were recorded. The 2006 Osteoporosis Position Statement of The North American Menopause Society was used for screening and therapeutic intervention guidelines.

Results: Among the 615 women with data, the mean (SD) age was 61.5 (8.3) years. Using the 2006 guidelines of The North American Menopause Society, 41.3% (253 of 612) of the women who had DXA testing did not meet the criteria for such screening. Of these women, 25.5% (157 of 615) were not taking calcium, 31.1% (191 of 614) were not taking vitamin D, and 59.8% (343 of 574) were not exercising at least half an hour per week. Of the women with any of the approved indications for treatment, 15.7% (16 of 102) were not taking calcium, 18.6% (19 of 102) were not taking vitamin D, 52.7% (49 of 93) were not exercising at least 2 hours per week, and 35.3% (36 of 102) were not receiving therapy. In contrast, of those women without an indication for treatment, 17.8% (83 of 467) were receiving bisphosphonate, raloxifene, or calcitonin therapy.

Conclusions: A large number of women are not properly screened or treated for osteoporosis. Inappropriate screening may also lead to improper management of osteoporosis and its associated complications.

Among women sent for dual-energy x-ray absorptiometry testing, this analysis assessed the appropriateness of screening and treatment based on current guidelines.

Received December 30, 2010; revised and accepted February 8, 2011.

From the 1Departments of ObGyn and 2Internal Medicine, The Reading Hospital and Medical Center, Reading, PA; 3Departments of ObGyn and 4Internal Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA; and 5School of Osteopathic Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, PA.

These data were presented in abstract form at The North American Menopause Society 21st Annual Meeting, Chicago, IL, October 8, 2010. These data and results, however, have not been published in manuscript form and have not been previously submitted to another journal.

Funding/support: The current research, data analysis, and manuscript preparation were funded by The Reading Hospital and Medical Center.

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Peter F. Schnatz, DO, FACOG, FACP, NCMP, The Reading Hospital and Medical Center, Department of ObGyn-R1, P.O. Box 16052, Reading, PA 19612-6052. E-mail:

©2011The North American Menopause Society