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A population-based osteoporosis screening program: who does not participate, and what are the consequences?
Diana S M Buist1, Andrea Z LaCroix, Susan K Brenneman
1Center for Health Studies, Group Health Cooperative, Seattle, Washington 98101, USA. Buist.D@ghc.org
Journal of the American Geriatrics Society
|June 24, 2004
Summary
Women who participated in an osteoporosis screening program had fewer hip fractures and started bone-preserving medication more often. This highlights the importance of osteoporosis screening for prevention.
Area of Science:
- Gerontology and Geriatric Medicine
- Public Health and Epidemiology
- Pharmacology and Therapeutics
Background:
- Osteoporosis poses a significant fracture risk, particularly in older women.
- Participation in osteoporosis screening programs can influence health outcomes and treatment initiation.
- Understanding differences between participants and non-participants is crucial for public health strategies.
Purpose of the Study:
- To compare osteoporosis risk factors, fracture rates, and antiresorptive therapy use between women who did and did not participate in an osteoporosis screening program.
- To evaluate the impact of screening program participation on health outcomes and medication adherence.
Main Methods:
- An observational cohort study involving 9,268 women aged 60-80, comparing 35% who participated in an osteoporosis screening program with 65% who did not.
- Participants received personalized osteoporosis risk feedback; some also underwent bone density testing.
- Automated administrative data tracked fracture outcomes and antiresorptive therapy initiation before and after invitation.
Main Results:
- No baseline differences in fracture rates were observed between participants and non-participants.
- After age adjustment, non-participants exhibited a higher hip fracture rate (14.1 vs. 8.3 per 1,000) and a lower rate of initiating antiresorptive therapy (10.3 vs. 17.9 per 100) over follow-up.
- These differences emerged after an average follow-up of 28-29 months.
Conclusions:
- Participation in the osteoporosis screening program was associated with reduced hip fracture rates and increased initiation of antiresorptive therapy.
- The study could not definitively attribute these differences solely to the screening program due to potential confounding or selection bias.
- Findings suggest proactive outreach to non-participants in screening programs is warranted to identify individuals who could benefit from osteoporosis prevention strategies.