161. Assessing Clinician Comfort and Screening Practices for Evaluating Bone Mineral Density in Adolescents and Young Adults with an Eating Disorder Based on Patient Sex

Abstract

Although extensive literature exists on bone health in female patients with an eating disorder, there are few studies on males. Clinical practice guidelines on eating disorder management currently focus on when to obtain Dual-energy X-ray absorptiometry (DXA) scans in females without guidance on when to assess males. Our study examined whether there are differences in clinician comfort and practices for assessing bone health based on the sex of the patient. We hypothesized that with more literature and guidance on the management of females, clinicians would feel more confident assessing female patients leading to higher DXA screening rates compared to male patients. Our 31-item survey queried clinicians from the United States using the Society for Adolescent Health and Medicine (SAHM) listserv about their confidence level and practices for assessing bone density in both male and female patients with an eating disorder. We performed McNemar chi-square analyses to assess for differences in rates of obtaining DXA scans and t-test analyses comparing factors affecting whether or not to obtain a DXA for a male versus female patient. Of the 104 clinicians who completed the survey, 54% identified as more confident assessing bone mineral density in females, while 0% identified as more confident assessing males. The remaining clinicians were either equally confident assessing both sexes (33%) or unsure (12%). In terms of screening rates, a vast majority of clinicians reported not obtaining a DXA scan during initial clinic visits for both males and females (90% vs 83%, p=0.390). Fracture history, degree of malnutrition, and duration of illness were the top three factors considered by clinicians when determining whether or not to obtain a DXA scan for male patients. Amenorrhea, fracture history, and duration of illness were the top three factors for female patients. When comparing reasons for ordering DXA between male and female patients, there was no difference for the following factors: age (p=0.880), degree of malnutrition (p=0.095), amount of weight loss (p=0.357), fracture history (p=0.078), hormone labs (p=0.090), duration of illness (p=0.150) and other (p=0.750). Findings support our hypothesis that clinicians feel more confident in assessing bone health in female compared to male patients with eating disorders. Despite this difference in confidence levels, there were no statistically significant differences in rates of obtaining DXA scans between the sexes nor in the factors influencing obtaining a scan. To our knowledge, this is the first study to examine specific clinician practices for assessing bone mineral density in patients with an eating disorder and the first to assess comfort level for obtaining a DXA scan. The findings suggest that more education and guidance on management of male patients may be needed to improve clinician confidence in assessing for decreased bone mineral density.