Changes in utilization of DXA screening for women and identification of risk factors for developing osteopenia and osteoporosis, 1999 through 2006: An upper-Midwest experience

Background: Practice guidelines, education and advertising combine to direct utilization of services, and have recently focused on bone mineral density (BMD) assessment. We sought to assess changes in dual-energy x-ray absorptiometry (DXA) use by women, from 1999-2006. Methods: All data for women's initial pre-diagnosis DXA scans for 1999-2006 (n=8571) was extracted from the Osteoporosis Program registry of a tertiary care center in the upper-Midwest. Each was classified as either: 1) Symptom–Diagnostic(n=1152); 2) Known condition-Elevated risk(n=1137); or 3) Screening(n=6282). Change by year and analysis of screening scans by year, age, and diagnosis were performed. Results: From 1999-2006 the number of DXA scans increased from 708 to 989, and the screening proportion rose from 61.6% to 81.9%. The proportion of younger women, <60 years, in the screening population increased from 38.1% to 58.3%. The proportion of the screening population diagnosed with osteoporosis/osteopenia decreased from 62.6% to 39.4%. Multivariate logistic regression of the screening population identified an elevated risk of osteoporosis/osteopenia (OR,95%CI) for women 60-74 (2.4,2.0-2.9) and 75+ (5.4,4.3-6.8), compared to <50 years. Women with lower body mass index (BMI) <34.9 were also at elevated risk, compared to BMI 40.0+, with highest risk at BMI <18.5 (10.3,5.4-19.6) Finally, year was significant, with 2001 through 2006 demonstrating lower risk (range .7,.5-.8 to .3,.2-.4), compared to 1999. Conclusions: Significant changes occurred over time, increasing the proportion of women screened for low BMD. However, the greatest increase was not in the geriatric portion of the population that would benefit most from DXA screening for osteoporosis.