Appropriateness of referrals to a tertiary referral centre for bone mineral density testing

Abstract

Evidence-based guidelines for who should have a dual-energy X-ray absorptiometry (DXA) scan are well established. Much attention has been appropriately focussed on increasing the proportion of persons at high risk for fracture who are being referred for such investigation. Little literature exists on the extent of inappropriate referrals for DXA. In this cross-sectional study we assessed the prevalence of inappropriate referrals for DXA studies at our centre using modified International Society for Clinical Densitometry (ISCD) guidelines. All DXA referrals were vetted for appropriateness and priority using established ISCD criteria. We evaluated the reasons for DXA referral on all subjects and studied the prevalence of missing information, and the number of referrals for DXA deemed to be inappropriate at our institution. Two thousand and twenty-five DXA referrals were reviewed. Information was missing on many requests (e.g., menopausal status, body mass index), and 33% of the referrals were deemed as inappropriate. Compared to those deemed appropriate, inappropriate referrals were more likely to be younger females, had no risk factors for osteoporosis, had an inappropriate referral reason, and had less/missing information. In this study we have noted a concerning number of DXA referrals with limited information or no appropriate indication for such an examination. Education of referring physicians should focus on not only improving referrals for subjects at high risk, but also inappropriate referrals for subjects at low risk.