Awareness of osteoporosis, risk and protective factors and own diagnostic status: a cross-sectional study

Appropriateness of bone density measurement in Switzerland: a cross-sectional study

Background

According to the WHO, osteoporosis is one of the most important non- communicable diseases worldwide. Different screening procedures are controversially discussed, especially concerning the concomitant issues of overdiagnosis and harm caused by inappropriate Dual X-ray Absorptiometry (DXA). The aim of this study was to evaluate the frequency and appropriateness of DXA as screening measure in Switzerland considering individual risk factors and to evaluate covariates independently associated with potentially inappropriate DXA screening.

Methods

Retrospective cross-sectional study using insurance claim data of 2013. Among all patients with DXA screening, women < 65 and men < 70 years without osteoporosis or risk factors for osteoporosis were defined as receiving potentially inappropriate DXA. Statistics included descriptive measures and multivariable regressions to estimate associations of relevant covariates with potentially inappropriate DXA screening.

Results

Of 1,131,092 patients, 552,973 were eligible. Among those 2637 of 10,000 (26.4%) underwent potentially inappropriate DXA screening. Female sex (Odds ratio 6.47, CI 6.41–6.54) and higher age showed the strongest association with any DXA screening.

Female gender (Odds ratio 1.84, CI 1.49–2.26) and an income among the highest 5% (Odds ratio 1.40, CI 1.01–1.98) were significantly positively associated with potentially inappropriate DXA screening, number of chronic conditions (Odds ratio 0.67, CI 0.65–0.70) and living in the central region of Switzerland (Odds ratio 0.67, CI 0.48–0.95) negatively.

Conclusion

One out of four DXAs for screening purpose is potentially inappropriate. Stakeholders of osteoporosis screening campaigns should focus on providing more detailed information on appropriateness of DXA screening indications (e.g. age thresholds) in order to avoid DXA overuse.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5305-0) contains supplementary material, which is available to authorized users.

Suboptimal bone protection in geriatric inpatients and effect of a simple educational and mnemonic strategy

AIM

Osteoporosis is underdiagnosed and undertreated in Australia, especially in hospitalised patients. We aimed to improve bone health management in geriatric inpatients by introducing a mnemonic into discharge summaries.

METHODS

A retrospective review of patients discharged from our geriatric unit was performed before and after intervention. Outcomes assessed were as follows: vitamin D measurement, bone protection medication and communication to general practitioners.

RESULTS

Sixty-one patients were included in the initial audit, and 82 in the reaudit. There was an increase in measurement of vitamin D levels (86.6% vs 57.4%, P < 0.001) and in the communication to the general practitioner (84.7% vs 28.6%, P < 0.001). Patients in the reaudit were more likely to have vitamin D initiated or increased (43.0% vs 7.4%, P = 0.001) and to have antiresorptive therapy commenced (9.8% vs 0%, P = 0.01).

CONCLUSION

The introduction of simple education and mnemonic strategy has shown significant improvement in the assessment and management of bone health in at-risk patients.