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Predictors of Screening and Treatment of Osteoporosis: A Structured Review of the Literature

Morris, Charles A. MD*; Cheng, Hailu BA†; Cabral, Danielle BA†; Solomon, Daniel H. MD, MPH‡

CME Review Article #8

Evidence exists that many at-risk patients are not screened or receive appropriate therapy for osteoporosis. We reviewed studies of bone mineral density (BMD) testing and osteoporosis therapy to describe predictors associated with screening and treatment of osteoporosis. We performed a structured review, searching MEDLINE and HEALTHStar from 1992 through 2002 using appropriate terms. Two authors examined all retrieved articles, and relevant studies were reviewed with a structured data abstraction form. A total of 277 articles were identified, and 35 met criteria for this review. Of these, 22 described screening patterns and 28 described treatment patterns. Seventy-one percent (25 of 35) of papers examined correlates of either BMD testing or treatment, and half (51%, 18 of 35) used multivariable analyses. Male patient gender and lack of subspecialist care were consistently associated with a higher risk of not receiving BMD testing; male physicians, generalist doctors, and those caring for fewer postmenopausal patients were more likely not to test patients. Younger patients, men, patients without a history of fracture, and those without subspecialist care were at higher risk of not receiving pharmacologic treatments. Six studies that examined treatment frequencies after bone densitometry all found that patients with osteoporosis by bone densitometry were at lower risk of not receiving treatment. Although the current literature is limited by inconsistent inclusion of common covariates and a lack of multivariable analyses, information about patient and physician correlations of osteoporosis management should help inform future quality improvement initiatives.

*Instructor in Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics and the Division of General Medicine; †Research Assistant, Division of Pharmacoepidemiology and Pharmacoeconomics; and ‡Assistant Professor of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics and Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.

Supported by the Arthritis Foundation and NIH K23-AR48616.

Dr. Morris is a stock shareholder with Pfizer and Dr. Soloman is the recipient of research grants from Merck, Pfizer, and Proctor & Gamble.

Ms. Cheng and Ms. Cabral have disclosed that they have no significant financial relationships with or interests in any commercial company that pertains to this educational activity.

Reprints: Charles A. Morris, MD, Brigham and Women's Hospital, Division of Pharmacoepidemiology and Pharmacoeconomics, 1620 Tremont Street, Suite 3030, Boston, MA 02120. E-mail:

Chief Editor's Note: This article is the 8th of 36 that will be published in 2004 for which a total of up to 36 Category 1 CME credits can be earned. Instructions for how credits can be earned precede the CME Examination at the back of this issue.

© 2004 Lippincott Williams & Wilkins, Inc.