title: Osteoporosis screening and treatment guidelines: are they being followed?
abstract: OBJECTIVE
  The objective of this study was to examine a cohort of women sent for dual-energy x-ray absorptiometry (DXA) screening to see whether they met the criteria for bone density testing. In addition, we sought to determine whether they were receiving appropriate interventions, based on published guidelines.
  
  
  METHODS
  Between January 1, 2007, and March 1, 2009, inclusive, postmenopausal women (age >49 y) who were sent for DXA bone density screening were offered enrollment into the study. Risk factors for osteoporosis, demographic information, and current DXA results were recorded. The 2006 Osteoporosis Position Statement of The North American Menopause Society was used for screening and therapeutic intervention guidelines.
  
  
  RESULTS
  Among the 615 women with data, the mean (SD) age was 61.5 (8.3) years. Using the 2006 guidelines of The North American Menopause Society, 41.3% (253 of 612) of the women who had DXA testing did not meet the criteria for such screening. Of these women, 25.5% (157 of 615) were not taking calcium, 31.1% (191 of 614) were not taking vitamin D, and 59.8% (343 of 574) were not exercising at least half an hour per week. Of the women with any of the approved indications for treatment, 15.7% (16 of 102) were not taking calcium, 18.6% (19 of 102) were not taking vitamin D, 52.7% (49 of 93) were not exercising at least 2 hours per week, and 35.3% (36 of 102) were not receiving therapy. In contrast, of those women without an indication for treatment, 17.8% (83 of 467) were receiving bisphosphonate, raloxifene, or calcitonin therapy.
  
  
  CONCLUSIONS
  A large number of women are not properly screened or treated for osteoporosis. Inappropriate screening may also lead to improper management of osteoporosis and its associated complications.
authors.affiliation: The Reading Hospital and Medical Center, Department of ObGyn, Reading, PA 19612-6052, USA. schnatzp@readinghospital.org
authors.forename: Peter F
authors.initials: PF
authors.lastname: Schnatz
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Marakovits
authors.forename: Melissa
authors.initials: M
authors.lastname: Dubois
authors.forename: David M
authors.initials: DM
authors.lastname: O'Sullivan
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002116:Calcitonin / Q000627:therapeutic use; D002136:Calcium, Dietary / Q000627:therapeutic use; D015331:Cohort Studies; D004164:Diphosphonates / Q000627:therapeutic use; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D017410:Practice Guidelines as Topic; D020849:Raloxifene Hydrochloride / Q000627:therapeutic use; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D050071:Bone Density Conservation Agents; D002136:Calcium, Dietary; D004164:Diphosphonates; D014807:Vitamin D; D020849:Raloxifene Hydrochloride; D002116:Calcitonin