title: Osteoporosis screening: factors associated with bone mineral density testing of older women.
abstract: BACKGROUND
  Osteoporosis is a major public health problem. Guidelines recommend osteoporosis screening, primarily with bone mineral density (BMD) testing, of all women aged > or =65 and younger women at increased risk. However, BMD testing is underused, and osteoporosis screening practices are not in compliance with guidelines.
  
  
  METHODS
  This was a retrospective cohort study of 809 women patients > or =65 years. The proportion of patients having evidence of BMD testing and factors associated with BMD testing were evaluated.
  
  
  RESULTS
  The overall proportion of patients having evidence of BMD testing was 42.9%. A higher proportion of patients from the gynecology practice (72%) had evidence of BMD testing compared with family medicine (42%), general internal medicine (36%), and the Veterans Administration practice (30%) (p < 0.0001). The proportion of patients with evidence of BMD testing was higher in patients seen by faculty (48%) than in patients seen by midlevel providers (35%) or residents (21%) (p < 0.0001) and was higher in patients of female providers (54%) than in patients of male providers (31%) (p < 0.0001). Negative associations with BMD testing were seen with increasing age and numbers of medications (p < 0.0001 and p < 0.05, respectively). The numbers of visits and numbers of total and unique ICD-9 codes were each negatively associated with BMD testing (p < 0.05, p < 0.005, and p < 0.05, respectively). In patients with commercial insurance, 48% had evidence of BMD testing vs. 25% in the rest of the subjects (p < 0.0001). The proportion of patients with evidence of BMD testing also varied by body mass index (BMI).
  
  
  CONCLUSIONS
  Consideration of factors associated with BMD testing may be useful in developing interventions to increase osteoporosis screening rates.
authors.affiliation: Department of Medicine, West Virginia University, Morgantown, West Virginia, USA. ldavisson@hsc.wvu.edu
authors.forename: Laura
authors.initials: L
authors.lastname: Davisson
authors.forename: Mary
authors.initials: M
authors.lastname: Warden
authors.forename: Shanthi
authors.initials: S
authors.lastname: Manivannan
authors.forename: Maria
authors.initials: M
authors.lastname: Kolar
authors.forename: Christine
authors.initials: C
authors.lastname: Kincaid
authors.forename: Shahida
authors.initials: S
authors.lastname: Bashir
authors.forename: Richard
authors.initials: R
authors.lastname: Layne
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000502:physiology*; D001851:Bone Diseases, Metabolic / Q000175:diagnosis; D005260:Female; D006801:Humans; D008403:Mass Screening; D010024:Osteoporosis / Q000175:diagnosis* / Q000517:prevention & control; D012189:Retrospective Studies