title: Suboptimal vitamin D screening in older patients with compromised skeletal health.
abstract: OBJECTIVE
  Increasing number of primary care visits for osteoporosis by older patients combined with new vitamin D screening recommendations necessitate primary care providers (PCPs) to identify and screen at-risk patients. We described prevalence and determinants of vitamin D screening among older patients treated for osteopoenia, osteoporosis and related fractures in academic outpatient primary care clinics (family medicine and geriatric medicine) in Houston, TX.
  
  
  METHODS
  Electronic chart review collected data on patients ≥50 years old from January 2008 to December 2010. Orders for serum 25-hydroxy vitamin D indicated vitamin D screening. Differences in patient characteristics were described between the groups with and without vitamin D screening. Age, body mass index, racial/ethnic background, bone-promoting medication (BPM) use and clinic types (family medicine versus geriatric medicine) were determinants for vitamin D screening in the regression analysis.
  
  
  RESULTS
  Patients were mostly women (95%), Caucasian (65%) and had a mean age of 69 ± 12 years. Twenty-two per cent of the family medicine clinic patients (total n = 78) and 51% of the geriatric medicine clinics patients (total n = 70) were screened. Older age (odds ratio, 0.94 confidence interval = 0.90-0.99) and BPM use (2.58, 1.03 to 6.45) were significant positive determinants for vitamin D screening.
  
  
  CONCLUSIONS
  In primary care clinics, vitamin D screening remains low among patients diagnosed with osteopoenia, osteoporosis and fractures. In light of new guidelines, suboptimal screening in the vulnerable older patients is disturbing. We recommend increased PCPs' awareness about vitamin D screening guidelines for improving skeletal health in older patients.
authors.affiliation: Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Texas Medical School at Houston, Houston, Texas, USA.
authors.forename: Nahid J
authors.initials: NJ
authors.lastname: Rianon
authors.forename: Kathleen P
authors.initials: KP
authors.lastname: Murphy
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Guanlao
authors.forename: Matthew
authors.initials: M
authors.lastname: Hnatow
authors.forename: Elaine
authors.initials: E
authors.lastname: De Leon
authors.forename: Beatrice J
authors.initials: BJ
authors.lastname: Selwyn
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D001851:Bone Diseases, Metabolic / Q000175:diagnosis; D005260:Female; D050723:Fractures, Bone; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology; D058866:Osteoporotic Fractures / Q000175:diagnosis; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood
chemical_list: D050071:Bone Density Conservation Agents; D014807:Vitamin D; C104450:25-hydroxyvitamin D
keywords: family medicine; geriatric medicine; older patients; osteoporosis; primary care; vitamin D screening