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- Title
Incidence and Predictors of Repeat Bone Mineral Densitometry: A Longitudinal Cohort Study.
- Authors
White VanGompel, Emily; Franks, Peter; Robbins, John; Fenton, Joshua; White VanGompel, Emily C; Robbins, John A; Fenton, Joshua J
- Abstract
<bold>Background: </bold>Existing guidelines for repeat screening and treatment monitoring intervals regarding the use of dual-energy x-ray absorptiometry (DXA) scans are conflicting or lacking. The Choosing Wisely campaign recommends against repeating DXA scans within 2 years of initial screening. It is unclear how frequently physicians order repeat scans and what clinical factors contribute to their use.<bold>Objective: </bold>To estimate cumulative incidence and predictors of repeat DXA for screening or treatment monitoring in a regional health system.<bold>Design: </bold>Retrospective longitudinal cohort study PARTICIPANTS: A total of 5992 women aged 40-84 years who received initial DXA screening from 2006 to 2011 within a regional health system in Sacramento, CA.<bold>Main Measures: </bold>Two- and five-year cumulative incidence and hazard rations (HR) of repeat DXA by initial screening result (classified into three groups: low or high risk of progression to osteoporosis, or osteoporosis) and whether women were prescribed osteoporosis drugs after initial DXA.<bold>Key Results: </bold>Among women not treated after initial DXA, 2-year cumulative incidence for low-risk, high-risk, and osteoporotic women was 8.0%, 13.8%, and 19.6%, respectively, increasing to 42.9%, 60.4%, and 57.4% by 5 years after initial screening. For treated women, median time to repeat DXA was over 3 years for all groups. Relative to women with low-risk initial DXA, high-risk initial DXA significantly predicted repeat screening for untreated women [adjusted HR 1.67 (95% CI 1.40-2.00)] but not within the treated group [HR 1.09 (95% CI 0.91-1.30)].<bold>Conclusions: </bold>Repeat DXA screening was common in women both at low and high risk of progression to osteoporosis, with a substantial proportion of women receiving repeat scans within 2 years of initial screening. Conversely, only 60% of those at high-risk of progression to osteoporosis were re-screened within 5 years. Interventions are needed to help clinicians make higher-value decisions regarding repeat use of DXA scans.
- Subjects
BONE densitometry; DUAL-energy X-ray absorptiometry; OSTEOPOROSIS in women; MEDICAL decision making; DIAGNOSIS; THERAPEUTICS; DENSITOMETRY; LONGITUDINAL method; OSTEOPOROSIS; BONE density; PREDICTIVE tests; DISEASE incidence; RETROSPECTIVE studies; PHOTON absorptiometry
- Publication
JGIM: Journal of General Internal Medicine, 2017, Vol 32, Issue 10, p1090
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1007/s11606-017-4094-y