Access to osteoporosis treatment is critically linked to access to dual-energy x-ray absorptiometry testing.
OBJECTIVE
To determine if inequities in access to osteoporosis investigation [dual-energy x-ray absorptiometry (DXA) testing] and treatment (bisphosphonate, calcitonin, and/or raloxifene) exist among older women in a region with universal health care coverage.


METHODS
Community-dwelling women aged 65-89 years residing within 2 regions of Ontario, Canada were randomly sampled. Data were collected by standardized telephone interview. Potential correlates of DXA testing (verified by physician records), and current treatment were grouped by type as: "predisposing characteristics," "enabling resources," or "need factors" based on hypothesized relationships formulated before data collection. Variables associated with each outcome independent of "need factors" identified inequities in the system.


RESULTS
Of the 871 participants (72% response rate), 55% had been tested by DXA and 20% were receiving treatment. Using multiple variable logistic regression to adjust for need factors, significant inequities in access to DXA testing existed by age, health beliefs, education, income, use of preventive health services, region, and provider sex. DXA testing mediated access to treatment; 34% of those having had a DXA were treated compared with 2% of those who did not. Among women with osteoporosis, correctly reporting that their DXA test indicated osteoporosis and higher perceived benefits of taking pharmacological agents for osteoporosis were associated with treatment.


CONCLUSIONS
Significant inequities in access to fracture prevention exist in a region with universal health care coverage. Improved access to DXA and better communication to patients of both their DXA results and the benefits of treatment has the potential to reduce the burden of osteoporosis.
Cadarette
Suzanne M
SM
Osteoporosis Research Program, Women's College Hospital, University of Toronto, Ontario, Canada. s.cadarette@utoronto.ca
Gignac
Monique A M
MA
Jaglal
Susan B
SB
Beaton
Dorcas E
DE
Hawker
Gillian A
GA
D015502:Absorptiometry, Photon / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data; D009864:Ontario / Q000453:epidemiology; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D011369:Professional-Patient Relations; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D016387:Women's Health