Patterns of medication use before and after bone densitometry: factors associated with appropriate treatment.
OBJECTIVE
We examined the medications used by women before and after bone densitometry to determine whether patient or physician factors were associated with appropriate osteoporosis therapy.


METHODS
Appropriate osteoporosis treatment was defined as alendronate, etidronate, calcitonin, or hormone replacement therapy (HRT) for women with any bone mineral density (BMD) t score < -2.5 or no osteoporosis therapy, except HRT, for women with t scores > -1.0. We observed a cohort of women who underwent bone densitometry at one outpatient osteoporosis clinic. Medical history, medication use, and demographic data were collected at the time of bone densitometry. A followup questionnaire assessed the medication use patterns since bone densitometry and attitudes about osteoporosis therapy.


RESULTS
We recruited 553 women who underwent bone densitometry in 1996. Their mean age was 62 years and 95% were postmenopausal. Prior to bone density scans, 27% of patients used HRT, 15% used bisphosphonates, and 6% used calcitonin. Scan results and surveys revealed that 40% of patients had BMD below a t score of -2.5 at any site. Of women with osteoporosis 78% reported taking an appropriate medication after their scans. Patients most likely to receive appropriate treatment were those who understood their bone densitometry results (odds ratio, OR, 2.5; 95% confidence interval, CI, 1.3 to 4.8) and patients who were taking an osteoporosis medication (OR 1.9; 95% CI 1.0 to 3.6). Neither the specialty of the referring physician nor patients' medical history was associated with use of appropriate osteoporosis therapy.


CONCLUSIONS
Of women with osteoporosis who underwent bone densitometry 78% received appropriate therapy after this test. Patient factors were associated with the likelihood that they received appropriate therapy, suggesting that strategies aimed at educating patients may improve the use of osteoporosis medications.
Solomon
D H
DH
Division of Rheumatology, Allergy, Immunology, Robert B. Brigham Multipurpose Arthritis and Musculoskeletal Diseases Center, Boston, Massachusetts, USA. dsolomon@rics.bwh.harvard.edu
Levin
E
E
Helfgott
S M
SM
D000368:Aged; D019386:Alendronate / Q000627:therapeutic use*; D015519:Bone Density; D002116:Calcitonin / Q000627:therapeutic use*; D003720:Densitometry; D004704:Endocrinology / Q000706:statistics & numerical data; D012968:Etidronic Acid / Q000627:therapeutic use*; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy*; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012219:Rheumatology / Q000706:statistics & numerical data; D016387:Women's Health
D002116:Calcitonin; D012968:Etidronic Acid; D019386:Alendronate