“Physicians who are ordering screening tests should focus on screening women who are at risk for osteoporosis,” Dr. Fenton told Reuters Health. “Clinicians who are interpreting DXA results should focus on the specific anatomic sites that are recommended for osteoporosis diagnosis.”
At his own institution, the researcher added, DXA reports no longer include lateral lumbar spine T scores. “We also need to get the word out to the interpreting doctors, many of whom are primary care physicians, about what are the diagnostic criteria for osteoporosis, who are the best candidates for screening tests, and then how do you factor risk into treatment decisions.”
Although the findings suggest that overscreening and overtreatment of low-risk patients are taking place, the opposite is also true, with many high-risk patients going without screening or treatment, Dr. Anne Schafer, of the San Francisco Veterans Affairs Medical Center, told Reuters Health in a telephone interview. Dr. Schafer coauthored an editorial accompanying the study.
“We know that many people who have already had a fragility fracture don’t get bone mineral density testing,” Dr. Schafer added. “We must screen and treat the right people.”
The new study does seem to show overtreatment of younger women without risk factors, according to Dr. Schafer. “For the women who were included in the study who had those osteopenia-range T scores but were older and did have risk factors, we can’t really say from this study whether treatment was inappropriate or not,” she added.
Reporting only T scores at the femoral neck, total hip, and posterior-anterior lumbar spine will help address confusion, Dr. Schafer and her colleague Dr. Tiffany Kim, also of the San Francisco VA, state in the editorial. These results, along with clinical risk factors including previous fractures, “should be used in the evaluation for skeletal fragility and in decision-making about lifestyle and pharmacologic interventions,” they conclude.
The National Institutes of Health, the Clinical and Translational Science Center, and the Agency for Healthcare Research and Quality supported this research. The authors reported no disclosures.
