Osteoporosis: evaluation of screening patterns in a primary-care group practice

An estimated half of all women aged older than 50 yr will have an osteoporosis-related fracture in their lifetime. National osteoporosis clinical guidelines for screening recommend measurement of bone mineral density in average risk women beginning at age 65 yr. Little data are available regarding compliance with this recommendation. The objective of this study was to evaluate osteoporosis screening rates in a random sample of women, aged 66 yr or older, in a large multisite primary-care group practice. The study was conducted in a primary-care group practice serving over 180,000 patients in the Denver metropolitan area. Medical records of a random sample of 833 female patients aged 66 yr or older were reviewed retrospectively. Patients were seen at 1 of 13 practice locations, by 1 of 34 physicians, who practiced either family medicine or internal medicine. The frequency of osteoporosis screening was calculated. Accepted methods of screening include peripheral bone density measurement by ultrasound or dual-energy X-ray absorptiometry (DXA), or central DXA. The physician-specific osteoporosis screening rates varied widely, ranging from 19% to 97%. The practice-specific osteoporosis screening rates ranged from 26% to 91%. Overall, the mean rate of osteoporosis screening among all physicians was 56%. Despite improvements in osteoporosis screening, there continues to be a gap in the quality of care provided compared to national recommended guidelines. Policy changes, performance improvement measures, and interventions are needed to improve screening rates in primary-care practices.